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AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please Check One: <br /> ❑ New ❑ Addition ❑ Remodel � Replace <br /> Job Site/Owner Information: <br /> Site Address: �7�� �e��y ' °✓ �'"`y <br /> 4�, a�c <br /> Owner: �'�y ° OrQ''`v Mailing Address: /� `, � �� <br /> City: ��s��i O4y z�p: s�3a 3 <br /> � <br /> Home Phone: Alternate Phone: 9��"��Q� ��� <br /> Contractor/Applicant Information: <br /> ` l',,, cr <br /> Contractor/App.: ��•1 k����� �y�-��� � Contact Person: ��� �""" <br /> Address: �°� �'�e �J� State License#: ^ C�� <br /> �. P.�I , 30 ,� ���y <br /> City: Zip: �S Expiratt�n 1atc: <br /> Phone: �������' 3��� Alternate Phone: <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> � Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> * Base Price=Contract Price: $ x A125 =$ (Minimum$50.00) <br /> *Surcharge=Contract Price: $ x.0005 =$ <br /> *Mail-In Fee(Only On Mail In Applications) _$ 2.00 <br /> --L_ <br /> *Total Cost of Permit: _$ <br /> The undersigned herby applies to the City for issuance of a Sprinkler Systems Permit. Applicant agrees <br /> that all systems shall be designed, installed and maintained to N.F.P.A.-l3,N.F.P.A.-25, Minnesota State <br /> Building Code, Minne ta State Fire Code and Standards, and certifies t at all statements made on this <br /> applicatio e com e,true and correct. <br /> �r�� �a.�r � �y�� <br /> Applicant Date <br />