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�-0013 <br /> AUTOMATIC FIRE SPRINKLER PERMITS <br /> Please Check One: <br /> ❑ New ❑ Addition [� Remodel ❑ Replace <br /> Job Site/Owner Information: <br /> Site Address: O/ <br /> Owner: tS��-0 S Mailing Address: �� <br /> City: Zip: <br /> Home Phone: (D!Z-2,17--SL�,l7 Alternate Phone: <br /> Contractor)Applicant lnfortxatton #, <br /> Contractor/App.: V i �r� Contact Person: -Ella Lf(1/i <br /> Address: 12,SN L1 b6g I t Slytt4- State License #: CUD <br /> City: "�"Pel Zip: Expiration Date: <br /> Phone: �5�^�j��vv Alternate Phone: <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkle <br /> r <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price: $r 91❑• x.0125 =$ (Minimum$35.00) <br /> *Surcharge=Contract Price:$24q 0-C k)x.0005 =$ A —7-5 (Minimum $ .50) <br /> *Mail-In Fee(Only On Mail In Applications) =$ 1.50 <br /> *Total Cost of Permit: =$ <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 /> IL&ut- 011 <br /> Applicant Date <br /> J <br /> Resorm Ci 8 <br /> - -v <br />