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�� ���� �33 �i��3 �/ oa�q <br /> �i <br /> Please check one: New j _ Addition Limited Energy Technolo;y <br /> � Systems License # <br /> G��, � n <br /> JOBSITE __�/�iG� � �����/ (✓ 2-� �-C <br /> i <br /> Owner's Name Telephone Number <br /> Mailing Address <br /> Sprinkler Contractor's Name ,c 1:r,;-+��;>l � �-�,�<� •� �- L�,��,�a,Telephone Number )C 3 - y j; -�j ;'� <br /> ! ,__ , <br /> ContactPerson /--r'�- ,T� �(r:=-}�,Z.�-.�.tU L <br /> � .__ `�.. <br /> Mailing Address l � ` � ` <br /> � � �,� , � <br /> f,`?� X > j � . %��, 4,�, ,, �.���, � `_ _� 5,-� l <br /> ��..C-' � <br /> i <br /> WATER SUPPLY <br /> Lake Well City ,'� <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinlclers /,� �t., �'�c" i� �/ <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: `j C! Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: �C GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <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 /> Applicant�'' �'!y�� � �'� � Date � G> <br /> x�*******************�**�x**�******��***�*****�****�*******�*�**�***�***��*******�* <br /> Approved_�_ Approved with Corrections� Denied <br /> Reviewed By: Date_ v� �f��Y <br /> . _. , :: _ _, _. _ _ _ <br /> - _`�.'�y►'I� U S�- � -�/� .. �'P 2 f€._ _ ���� ��,^-� l � ��� - <br /> _ _ _ <br /> _ . _ .� <br /> �. - <br />