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• <br /> •zw.:r�lshiMs�- <br /> AUTOMATIC FIRESPRINKLER PERMITS; i <br /> Please Check Oe <br /> n New Addition EI Remodel Replace <br /> Job Site/Ower Informati n �.. <br /> Site Address: 550 O .Ci 5 60,k, a <br /> u <br /> Owner: Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Infos iation <br /> N0, avlc hvxjc.Contractor/App.:AL Y th C. V1 r Contact Person: 7-9310((v)13 <br /> Address: 30X01 10-- /r1:1 1.11.1C1C.....4Sgi State License#: CCA )-- <br /> City: 01O.,C,V\G Zip: c- P(4-q Expiration Date: CO/30/i <br /> [ �-- <br /> Phone: 76n ci-ecio a--- Alternate Phone: <br /> T ' TYPES ►FTEMS ite4 LER PL * ''s , <br /> Commercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> cTc34-)*Base Price=Contract Price: $Ap,Cr�rUU x.0125 =$ --OO , (Minimum$35.00) <br /> w <br /> *Surcharge=Contract Price: $/ ,c E x.0005 =$ c� <br /> *Mail-In Fee(Only On Mail In Applications) =$ 2.00 <br /> *Total Cost of Permit: =$ v2 i <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 /> applicatiol complete,true and correct. <br /> o„....e.......e.9.,.... : e;2/S <br /> � <br /> Applicant ,s5".. Date <br /> l <br /> Reset Form <br />