Laserfiche WebLink
40. <br /> 7-�1 of <br /> ❑ New ❑ Addition [ ] Remodel ❑ Replace <br /> Site Address: 1L (id ri ( bab . <br /> Owner: U Ptc) /or I : A. . J,� Mailing Address: 1r'���`� '/'1 cQ <br /> City: alln C) Zip: 335t0 <br /> Home Phone: (Q 1 0/ia "/") 9 Alternate Phone: <br /> /_ `u ) <br /> Contractor/App.: I , . �,/, �� // • flk ontact Person: 1 (�Q f/ a tais� <br /> Address: 0 � / //, �i/� State License #: <br /> *61�.S <br /> City: a - PO& Zip: w7 Expiration Date: LO/O / <br /> Phone: 1051 551 (Y) Alternate Phone: <br /> i ; "_'- K_.. r#7505777 sr °., <br /> _ ^ <br /> ommercial—Fire Sprinkler ❑ Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> LL— <br /> *Base Price=Contract Price: $ x.0125 =$-Z (Minimum$35.00) <br /> *Surcharge=Contract Price:$ x.0005 =$ 5(J (Minimum $ .50) <br /> *Mail-In Fee(Only On Mail In Applications) =$ 1.50 <br /> *Total Cost of Permit: =$1/ <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 /> .plication are complete,true and correct. <br /> I� /,ca(4/0 1-7 -73 -6& <br /> Applicant Date <br />