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w. w <br /> 4,�b <br /> r <br /> AUTOMATIC FIREbra ^ e' �E...s� -� <br /> _. „ . �. ...�. r.,�,. <br /> Please Check One: <br /> New Li Addition n Remodel ❑ Replace <br /> Job Site/Owner Information: <br /> Site Address: 1450 .cNSVc,k b 0--A (C <br /> Owner: Jew ec��t ca 1 Mailing Address: OL. Cy 5 1 !ay rc <br /> City: ©eO*'O Zip: 6535L- <br /> Home Phone: 4 S?.. "t")3 -50 1 .L Alternate Phone: <br /> .11 <br /> Contractor/App.: c.cit. ,r,,rt Prt} 0" Contact Person: ,Sv •V� <br /> Address: 3O00 (te‘ktwi IL rc State License #: C= 08C0 <br /> City: L:A-k\e-CO- ck Zip: T511/ Expiration Date: (p <br /> Phone: (,S) -7') — fj7� Alternate Phone: Co551 •-5S6 -1-i(,14 <br /> TYPES OF FIRE SPRINKLER PERMITS <br /> Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price: $ .31)430•41:)- x.0125 =$ 1-1-73 ,i5(Minimum$50.00) <br /> *Surcharge=Contract Price: $ 37,°ip0°` x.0005 =$ E U .9 <br /> * Mail-In Fee(Only On Mail In Applications) =$ 2.00 <br /> *Total Cost of Permit: =$ 1-1q4..-70 <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 • - c•• plete,true and correct. <br /> A o Date <br />