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. �o0 9��a��7 <br /> . ,�, . <br /> Please check one: New ✓ Addition Limited Energy Technology <br /> Systems License# <br /> � <br /> JOB SITE ��S ��,n �r��,�J � ., <br /> Owner's Name_ C��` i`�)� Telephone Number <br /> MailingAddress �U S (.��vwn 2„�,� S � <br /> Sprinkler Contractor's Name�v�- }—^�gyy�„�� ,�h�'elephone Number�,�? � g�/�//3� <br /> Contact Person �� 1`C-e <br /> Mailing Address G �G� C 1�-'� �.�{-- �c,}2�KvV y � <br /> WATER SUPPLY / <br /> Lake Well �/ City <br /> BACKFLOW DEVICE / <br /> AVB PVB ,/ <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers -�/��I-�✓( ,(�� � 7�� Li�/ <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: `3�� �� Sq. Ft. <br /> Coverage per Sprinkler: 3v r�,�,'� Sq. Ft. <br /> No. of Sprinklers: tl�( <br /> Total Water Required: �� � GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharee $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3S.S v <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and State regulations,and certifies that <br /> all statements made on this application are complete, true and correct. <br /> Applicant �+--�. Date s ` �` ��� <br /> ****************� ***�*********************************************************** <br /> Approved /' Approved with Corrections �� <br /> Reviewed B : �`�,�.J �` � <br /> Y -� '�. �.�C/� Date �- �oL 0 �( <br />