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L vv ccy-� e r b 1 15 Co <br /> o — <br /> �. � � �ti. <br /> � <br /> D -D/S4�� I-1 CITI(OF ORONO <br /> e , <br /> F� <br /> New ❑ Addition ❑ Remodel ❑ Replace <br /> Backflow Device: ❑ AVB ❑ PVB Ame v Zm-dSS <br /> 1 mac°° <br /> Site Address: b 8 S ®L-D GR YS?AL- r3Ar R(SAo No21rt,, <br /> Owner: ORONO PUPAU C r Mailing Address: 685-N OLo ctf3ay R� <br /> City: ORONO Zip: SS 3'j'G <br /> Home Phone: C(6'2-- 441- r63oc� Alternate Phone: <br /> C�:h� � ►�tae � �nl�r�rt �,t1Q� r �, �' <br /> Contractor/App.:_/VWA FIR01 Rarr-c-ets.-i Contact Person: A-r LAacc ej <br /> Address: Soy yl S< S W State License#: C o t a <br /> City: r-MG 1 Zip: 5/b3 Expiration Date: <br /> Phone: 7u1 Za2- c>?-,c 8 Alternate Phone: <br /> Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price:$35l Som x.0125 =$ qy 3. 7,5-7 (Minimum$50.00) <br /> *Surcharge=Contract Price:$ 3s, Sup x.0005 =$ 17- <br /> Mail-In <br /> 7•Mail-In Fee(Only On Mail In Applications) =$ 2.00 <br /> Total Cost of Permit: =$ q63. 5— <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 compl e,true and correct. <br /> MATJ~7 <br /> Applicant Date <br />