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r ''�' � <br /> \�`�� <br /> � AUTOMATIC FIRE SPRINKLER PERMITS � � <br /> I� �� <br /> �'�ease Check Une: ��L��� <br /> ❑ New ❑ Addition �] Remodel ❑ Replace <br /> Job Site/Owner Infc�rmatian: <br /> }.� , <br /> Site Address: ����aS I\,�����u� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> uome Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.:��� ��v�- ����-��rt Contact Person: ��. w. �--�, r,c-� <br /> Address: �1,�'�I� �, �ovr,cl L,I� �� State License#: (`�O l �-{ <br /> City: � � � Zip: �� Expiration Date: <br /> Phone: Alternate Phone: (,��%- (G 3(�� )/�/ <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:$ c�-� . x.0125 =$ �� • (Minimum$35.00) <br /> * Surcharge=Contract Price:$ x.0005 =$ N S� (Minimum $ .50) <br /> * Mail-[n 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 agrees <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 /> �. '���sc �- CI' '�1 - �(f. <br /> Applicant Date <br /> . „����-R��/'�D <br /> Reset Form � <br /> 5 EP 2 8 2006 <br /> C`TY QP= aR�Nn <br />