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�'` AUTOMATIC FIRE SPRINKLER PERMITS <br /> � ' <br /> �'Please Check One: <br /> ❑ New � Addition ❑ Remodel ❑ Replace <br /> Job Site/Owner Information: <br /> Site Address: Z i g C� �G�.��-\ S� ���Z--� � .J��Z . <br /> Owner: ��� t-L �C:1>c�(�(� Mailing Address: <br /> City: ����� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App���1-_�-;�i�1 �� '�L�. ��v Contact Person: I`��v)t�'� <br /> Address: �z-1 \,�.1 �t.-�,���---� �� 0�1�: State License#: C� 4 � <br /> City: �> >�J--5 Zip: �� Expiration Date: � �- L� � <br /> G�.�-L. <br /> Phone: (9 IZ ?,`�1 — '�\ l \ Alternate Phone: (r��Z Z�'IC 41 O O <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> � Commercial-Fire Sprinkler ❑ Residential-Fire Sprinkler <br /> Fire Systems Permit Fire Systems Pennit <br /> *Base Price=Contract Price: � )L,(�C�O. x A125 =$ ' �` � (Minimum$35.00) <br /> �2 .00 <br /> *Surcharge=Contract Price: $ x.0005 =$ .�� (Minimum $ .50) <br /> *Mail-In Fee(Only On Mail In Applications) _$ � ��A <br /> *Total Cost of Permit: _$ � <br /> ,1� zs >,oa o <br /> (�t�p/1 I<G ►� S�2T'�=� �,,r T�+o� ; �6��l.v�, i r - SN�.�PS� 6 A-r�o�-.+ r''�� pC -G- <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 a e complete,true and correct. <br /> � ���� Z�'� �� <br /> Applicant Date <br /> «, <br /> ; ; <br /> Reset Form <br /> ��P ro��� ��.��� � ° 6 <br /> �.�..L.0 �-w��,,.�� <br />