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, <br /> AUTOMATIC FTRE SPRINKLER PERMITS <br /> Please Chec�Gne: <br /> ❑ New ❑ Addition ❑ Remodel � Replace��'��c���' <br /> Job Site/Owner Information: <br /> . -, . <br /> Site Address: -� �C:�t-� �- C:\, � ��`%`• <br /> � <br /> Owner: ` Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> l . � . . ` <br /> Contractor/App.; '1.�:� �•.,nc� � ��1,�v Contact Person: j-11/�- ' �� = C ✓1 ' <br /> � L. � i l_. ��_ )�i L � <br /> �� I + . � <br /> Address: ��v � V�_�Y�� U'1 ��-�-� State License#: �� �-" <br /> C � ��_ <br /> City: �,O.,l�'�k...� Zip: ����1 Expiration Date: � �: � � <br /> � ( , � � <br /> Phone: ��L� ��4.--�` 1��. AlternatePhone: ��" � - � � <br /> TYPES(?F FIRE SPRINI�LER PERMITS <br /> �Commercial-Fire Sprinkler ❑ Residential-Fire Sprinkler <br /> Fire S�stems Pennit Fire Systems Permit <br /> * Base Price=Contract Price: $ � ' ��� x A125 =$-��`�—� ) <br /> *Surcharge=Contract Price: $ C� x.0005 =$ b� �G� <br /> * Mail-In Fee(Only On Mail In Applications) _$ 2.00 <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.-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 /> ication e cam ete,true an orrect. <br /> ,�r� ' � �" �-� <br /> Applicant Date <br /> Reset Form <br /> � � � <br /> �. � <br /> ��y" _ o� - r 'z- <br /> � r <br />