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AUTOMATIC FIRE SPRINKLER PERMITS <br /> New ❑ Addition ❑ Remodel ( I Replace <br /> Backflow Device: n AVB ❑ PVB <br /> Job Site/Owner Info a ati® . <br /> \ Site Address: - CA% ?c‘, , : .cal <br /> t Owner: /h> r r S Mailing Address: '7 6 0 Or'C,I -Ca Pe K got. <br /> City: drrvt o Zip: 5c S6 <br /> Home Phone: Alternate Phone: <br /> Contras or •pp 1 cant Information' <br /> Contractor/App.:y i k;n Au3o Wim;C., SFr; 14-1 erContact Person: g00 <br /> ( <br /> Address: 30 I lbe k 4Ve-- State License#: t C0c <br /> City: �'. P.k I Zip: 55 I o Expiration Date: ( /30/ ZO 17 <br /> Phone: 6 - 5-58- 3 7,12 Alternate Phone: <br /> I d t ' 11.1►4 ; CAI <br /> ❑ Commercial—Fire Sprinkler Residential—Fire Sprinkler <br /> Fire Systems PermitFire Systems Permit <br /> *Base Price=Contract Price: $) 7)())'2 5 x.0125 =$ 1•2-11)• 3 f (Minimum$50.00) <br /> *Surcharge=Contract Price:$ 1 7) b2s x.0005 =$ 13• o I <br /> *Mail-In Fee(Only On Mail In Applications) =$ 2.00 <br /> *Total Cost of Permit: =$ 1-S1. 1 2 <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 /> 6—Zetj 1C'/12/2-016. <br /> Applicant Date <br />