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RE, <br /> New ❑ Addition ❑ Remodel ❑ Replace <br /> L.�,Rackflow Device ❑ AVB ❑ PVB AMr .c Zn.dSS <br /> Site Address: 6 f3S OL-D GR YS-rAL r3AY R dA,o No2114 <br /> Owner: ORD-No PuR r_ cjwAond.r Mailing Address: G&5W oLo cctf3r-y tta^o <br /> City: ORO"o Zip: SS 3'S G <br /> Home Phone: C(52-- 441- `d304=1 Alternate Phone: <br /> Contractor/App.: AJOVA f /2C /hyMP!u j Contact Person: nrr LAf?conl <br /> Address: Soy yl sI S< Sw State License#: C G <br /> City: r/�G%> Zip: 5 103 Expiration Date: <br /> Phone: '7u 1` c>?-,c 8 Alternate Phone: <br /> ily .. e.,.. �.. r4t,:'Y." e <br /> r <br /> Commercial-Fire Sprinkle r ❑ Residential-Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> •Base Price=Contract Price:$35 500 x.0125 =$ qy 3. 7,5-7 (Minimum$50.00) <br /> *Surcharge=Contract Price:$ 3s, Soo x.0005 =$ -7• - <br /> *Mail-In Fee(Only On Mail In Applications) <br /> Total Cost of Permit: _$An <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 �e, correct. <br /> )2/1 /1-7 <br /> Applicant Date <br />