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' ac I RECEIVED <br /> , <br /> dof7 vjtts,,. !11 <br /> CITY OF ORONO <br /> ✓` i New I I Addition ❑ Remodel I I Replace <br /> Backflow Device: n AVB n PVB <br /> � <br /> Site Address: � <br /> C --.1 (md(N- I )) ir)� <br /> , �k ) <br /> Owner: Li-f_ L %! - -' . � Mailing Address: -9---- U€-,Ci'C ' ' <br /> City s ia,'--Qin) Zip: <br /> Home Phone: cic)A. Cj-OC 17-) Alternate Phone: <br /> tea, <br /> Contractor/App.: LI - ( (--',-'{___(2 Contact Person: ."c. 5 <br /> L_ <br /> Address: 1L C' t� �_(1 � State License#: C,05 <br /> City: 6(; AQAm\JP) ZipC� Expiration Date: —( —< <.� <br /> Phone: 7 3-.1.5-46-).)N— --D,:-1------r)- — Alternate Phone: <br /> a'w, '/ ¥ a ' a s r6 ..,.,. ":� €< :. <br /> I nmmercial—Fire Sprinkler Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit _ <br /> * Base Price=Contract Price: $�( 1 x.0125 =$ 3 �� (Minimum$50.00) <br /> * Surcharge=Contract Price: $ x.0005 =$ (-11:F.) <br /> * Mail-In Fee(Only On Mail In Applications) =$ 2.00 <br /> * Total Cost of Permit: =$ C 7 j <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.na <br /> 1 ,,V <br /> Applicant /) Date <br />