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. <br /> i <br /> Please check one: New Addition ! � <br /> JOB SITE <br /> Owner's Name ��� z i,'�- �,�-; �_; TelephoneNumber <br /> Mailing Address �;1� / e�;,�»/��p r�,' ��� . � <br /> L <br /> Sprinkler Contractor's Name �G/'� _j��-,�ti.�jt;�,�� i�� TelephoneNumber �'��-��. ��f� � F ��-;�' <br /> Contact Person " <br /> lii�<< r�c� <br /> � ;� , <br /> Mailing Address /�� ,� �- ��.�� �+ r/,.� ���` 1 �,:r; . _ � ,� ���, ,�, <br /> � � =��. <br /> WATER SUPPLY <br /> Lake Well i�' City <br /> BACKF�,LV W DEVI p� � `��� (� - <br /> �;, <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers /1/� �`�'' ' ��%� t<_-. - �,,� : �- <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: GpM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 3 5.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �5`� -� � <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 /> � <br /> �� , , <br /> Applicant .��� "'��" � Date i " " � � ��, <br /> ***************************�**************************************************** <br /> (� � <br /> Approved M� Approved with Corrections���I �p�v�enied <br /> Reviewed by: {� <br /> '��� q �,'r:� '��-N-� Date �—���� <br /> � <br /> -w�_�� b� a�+� ^�t� ��-.�bv..\� �`�f� ) -w��"� (l 1F��"��^�`\ , <br /> � �� J <br />