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_ <br /> � i��� <br />�� : � ���^� ��� C � � �� � 7/D� <br /> AUTOMATIC FIRE SPRINKLER PERMITS � <br /> r�. <br /> � ; i. <br /> Please Check One: � y�' � <br /> ,� � � G <br /> ❑ New ❑ Addition ❑ Remodel �J Replace a' � <br /> °� o v <br /> Job Site/OWner lnformatrc�r� � � a' <br /> � <br /> � O <br /> Site Address: ` <br /> Owner: �l`�\ l� AJ `�, � ���-� Mailing Address: <br /> City: ��Ov,�`� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.:� � \� ^ �L`Vl��dzlSact Person: ��� v ��� <br /> Address: `�1\ � C`�l.t ��1t State License #: � -L'��� <br /> City: �L, ���� Zip: �\�� Expiration Date: �`V�� <br /> �, <br /> Phone: ���\ �j`'S���L�, Alternate Phone: ��� ��� '�5 <br /> �- �_ TYPES OF FIRE SPRINKLER PERMITS <br /> �Commercial—Fire S rinkler ❑ Residential—Fire S rinkler <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price: $�F�_ x.0125 =$ �_ (Minimum$35.00) <br /> *Surcharge=Contract Price:$�_ x.0005 =$ ��� (Minimum $ .50) <br /> * Mail-In Fee(Only On Mail In Applications) _$ 1.50 <br /> *Total Cost of Permit: _$ � �j� <br /> The undersigned herby applies to the City for issuance of a Sprinkler Systems Permit. Applicant agees <br /> that all systems shall be designed, installed and maintained to N.F.P.A.-13,N.F.P.A.-25, Minnesota State <br /> Building Code,Minnesota State Fire Code and Standards, and certifies that all statements made on this <br /> application are complete, true and correct. <br /> \ �` \�,�\ �,��, <br /> '� `�`�C,. � <br /> Applicant Date <br /> E * ' Reset Farm <br /> �..� ; r <br /> �f��'' ���c�L c,/ lG�l 6 / a 6 <br /> �-�� �' <br />