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A �, <br /> AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please Check One: <br /> ❑ New ❑ Addition � Remodel ❑ Replace <br /> Job Site/Owner Information: <br /> Site Address: _ Z7�G �t.�<<-y �2r��� <br /> Owner: C�kv c�- ��c'v�.c-� Mailing Address: <br /> c�ty: �-��� z�p: 5�3� <br /> Home Phone: �`t52� Z.�y_�{(,�j Alternate Phone: <br /> Contractor/Applicant Information: <br /> �_• <br /> Contractor/App.:�����'� � •ti ��b•kc�-�cr. Contact Person: � �v� �i��cr�.�.�� <br /> Address: S15 1�:�,.,�.�,al-� ,�.� �� State License#: �-�7�J <br /> � G � �S <br /> City: �"�•�2v 11 Zip: �SlU3 Expiration Date: � <br /> Phone: C��� 25�- 18�7 l Alternate Phone: �CoSI� 2�4—(o(oZ� <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> � Commercial—Fire Sprinkler ❑ Residential —Fire Sprinkler <br /> � <br /> I ire Systems Pennit 1=ire Systems Permit <br /> * Base Price=Contract Price: $ x.0125 =$ (Minimum$50.00) <br /> *Surcharge=Contract Price:$ x.0005 =$ �1 U �� <br /> IV '�� ��� <br /> *Mail-In Fee(Only On Mail In Applizations) _$ 2.00 (�'��� �� <br /> *Total Cost of Permit: _$ L.Y(Z �y„��^ , <br /> � <br /> ��C.��� � k�c1lS �r�r l�.�..� w211) �� C��.;c� . <br /> — <br /> The undersigned herby applies to the City for issuance of a Sprinkler Systems Pennit. Applicant agrees <br /> that all systems shall be designed,installed and inaintained 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 /> app�tion are coi lete,true and correct. <br /> �� �� .C---'�; <br /> � 22 l� <br /> Applicant ; Date <br />