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AUT4MATIC FiRE SPRINKI.ER PERMTTS <br />, � 'Pleas� C�ec�C C�ne' <br /> ❑ New ❑ Addition ❑✓ Remodel ❑ Replace <br /> _--- - <br /> Job Site/Owner 1r�fc�rmatioti: � � � <br /> '_76� �ticllcy Purkway <br /> Site Address: <br /> Minnesota Maxillofacial and Oral <br /> Owner: Mailing Address: <br /> Orono 55356 <br /> Clty: Zlp: <br /> Home Phonc: Alternate Phone: <br /> Co��tractor/Applicant lnformation: <br /> Escapc Firc Protcction Ryan Kunst <br /> Contractor/App.: Contact Person: <br /> 3020 Ccnterville Road C-086 <br /> Address: State License #: <br /> Little Canada,MN 551 17 July 1 st 2007 <br /> City: Zip: Expiration Date: <br /> (651)771-8874 (65l)755-3230 <br /> Phone: /�lternate Phone: <br /> ' TYPES QF F�R� �PRINKLER�'ERMITS <br /> 0 Commercial - Fire Sprinkler ❑ Residential-Fire Sprinkler <br /> Firc Systems Permit Fire Systems Permit <br /> * Base Price=Contract Price: $ �°�'00.00 x.0125 =$ 35.00 (Minimum $35.00) <br /> ''` Surcharge=Contract Price: � ��600.00 x.0005 =$ ��30 (Minimum $ .50) <br /> x Mail-In Fee(Only On Mail In Applications) _$ 1.50 <br /> 37.80 <br /> * Total Cost of Permit: _$ <br /> The �►ndersigned herby applies to the City far 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 compl te, true and correct. <br /> � - _ � <br /> / Z3 � <br /> Applicant Date <br /> Reset Form <br />