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, � , . � <br /> :� X�.�: �,. <br /> � � I p`� <br /> �h�' � c� ��, � �.���;� �^_O 1 <br /> D � r <br /> ' <br /> ❑ New ❑ Addition �[ Remodel ❑ Replace <br /> i;F i�, <br /> �F:. <br /> Site Address: �I �J N D R-�N 5 H�o i�-��- � '�� <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> �.� �� <br /> �v 93.. <br /> Contractor/App.:S�.�� f►a��- �Oi��n°�ontact Person: '7�+}N w�3f'z�(Z- <br /> Address: �hY 3 9 ►.}c,v✓, f 2 5,w State License#: L-o o � <br /> P�o �c X G�g <br /> City: wAv ri��" Zip: S�3 4 D Expiration Date: (o - 3 0 -0 9 <br /> Phone: '� b 3_ `S�-y Y n� Alternate Phone: <br /> � �� � n� ,. �� ��, <br /> � Commercial-Fire Sprinkler ❑ Residential-Fire S�rinkler <br /> Fire Systems Permit Fire Systems Permit <br /> �,� 2� <br /> * Base Price=Contract Price: $ l(o � 7 (�' x.0125 =$ Z1 Z- (Minimum$35.00) <br /> s,j- y� <br /> *Surcharge=Contract Price:$ � 7 V x.0005 =$ d ' (Minimum $ .50) <br /> *Mail-In Fee(Only On Mail In Applications) _$ 1.50 <br /> �9 <br /> *Total Cost of Permit: _$ Z ZZ � <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 /> I <br /> /p � 20 -O� <br /> Appli t Date � <br /> � <br /> � , �� ' r ��s;�Mr � � �� ��� � <br /> ��� ,f' €� ..�.����.�,a � ��. .xe �F��r V J C.C� r �/ ���(.� �'J <br /> ��� <br />