Laserfiche WebLink
� <br /> . �� � ,-��► -- �s�p�'�i <br /> AUTOMATIC FIRE SPRINKLER PERNIITS <br /> Please Check One: <br /> � New ❑ Addition ❑ Remodel ❑ Replace <br /> Job Site/Owner Information: <br /> Site Address: ��I � l��h 1�y P e- ��n� <br /> Owner: �G.� ����-� Mailing Address: <br /> City: ���v� O Zip: �j S 35 `� <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> � J <br /> �� ��e /"�o�. Contact Person: j �� <br /> Conti•actor/App.:�(J•rl.yt-� <br /> l— <br /> Address: 5� /''7�^'�e� '� /�vP W State License#: CO 7S <br /> City: �'�• �G Zip: .�S�v3 Expiration Date: � �� (o <br /> Phone: Co S �"Z S I-� ��� Alternate Phone: <br /> TYPE5 OF FIRE S�'RINKLER PERMITS <br /> ❑ Cotnmercial—Fire Sprinkler � Residential—Fire Spri��kler <br /> Fire Systems Pemiit Fire Syste�ns Permit <br /> �ao <br /> *Base Price=Contract Price: $ ��� x.0125 =$ � 7�O..S� (Minimum$50.00) <br /> *Surcharge=Contract Price:$ F_ x.0005 =$ aU <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 Pennit. 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 C de, Minnesota State Fire Code and Standards, and certifies that all statements made on this <br /> applicati are complete e and correct. <br /> � <br /> 1��_ 7-�5 <br /> Ap licant Date <br /> �.� �'-'��''�� <br /> � <br />