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15 ) 1 - 2Z. <br /> . . AUT,,QIV.L�;3'IC TIRE SPItINIKLER_PTRMITS _ :;� <br /> Pease Chec One <br /> ❑ New ❑ Addition ❑ Remodel Replace <br /> Job Site/Owiie'Information <br /> Site Address: TOO 0 1 d Cr tic rI 1 P of i i N <br /> Owner: O,.pc.D Mr JMj. S(.j a) Mailing Address: roo Di/ crt J sf ! Aay 2d N <br /> City: (Or Ara) Zip: 5 <br /> Home Phone: 9 S t- yY y- pic0 Alternate Phone: <br /> ContKactor/Applicant <br /> Contractor/App.: l_ UC r n c., Contact Person: Litter^ <br /> Address: ,Z oa cot, ?ed.( S t State License#: <br /> City: OL Zip: 5 5tS Expiration Date: <br /> Phone: 9 SZ -fir 7 rZ 9 Alternate Phone: <br /> TYPES OF FIRE SPRINKLER PERMITS}... . <br /> [/Commercial—Fire Sprinkler D Residential—Fire Sprinkler <br /> Fire Systems Permit Fire Systems Permit <br /> *Base Price=Contract Price:$ y i cSoo x.0125 —$ 5 7,0 6 (Minimum$50.00) <br /> * Surcharge=Contract Price: $ y t 6 5,,D,, x.0005 =5 Z,.o <br /> *Mail-hi Fee(Only On Mail In Applications) _$ 2.00 <br /> *Total Cost of Permit: _$ 56. 1 y <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.-1 3,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 /> ///rz/z.ot5 <br /> Applicant Date <br />