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r �� � ` � Y � o �-�-pp� ��. c�^'`� ��'��� ���s <br /> w��� �`g�' <br /> ��Z- � /c>S <br /> g�`3 S.S�v <br /> �Please check one: New� Addition Limited Energy Technology <br /> � S stems License # <br /> ��i"� <br /> JOB SITE � �)JO � I �r> �� �Y1 � <br /> Owner's Name Telephone Number <br /> Mailing Address , 'j�/YI E. <br /> "�C er5 <br /> Sprinkler Contractor's Name �17��,��� L.��n P r' Telephone Number�,��,Z - SC��j-/ 7 �8 <br /> Contact Person �,�,�,,�Q ��m e Z <br /> Mailin�Address y��9n �i Q��q y�-� /�. <br /> WATER SUPPLY <br /> Lake_� Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers ►� r� •� ►a• � ,) I S�'�;y �2 7 <br /> - r�v�� � ��r� � �� �a <br /> _ rl� � o e� �1�-'� - A l�J j,��— <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 $ 35.00 <br /> 2. State SurcharQe <br /> $ .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 "-' ' ' � ��� �' Date�1 G-5 <br /> c <br /> ******��*********��****************��*�****�****�******************************** <br /> Approved w (,� Approved with Corrections Denied <br /> Revie�ved By: �����{. ��� Date ( ' � �� �' -� <br />