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� /6 �40� <br /> � <br /> Please check one: New Addition . <br /> JOB SITE � �'`{�' ,-�h A� c�� c.� � l IZ � Civ �4 �-.�� 'f f�t � <br /> Owner's \Tame (',� ��� � �� Telephone Number <br /> Mailing Address_�� Cr-r> , _/�,E7 r� � r a� �c���,� �Z� ,,�,, A t� ��. � <br /> � Ss3p� <br /> Sprinkler Contractor's Name� ��lVl� C /-�- Telephone Number �� Z� <br /> Contact Person U �j= <br /> � <br /> Mailing Address ? 7 9'c� � /' � � �.� � � �� r ���•� <br /> � <br /> WATER SUPPLY <br /> Lake � Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantity <br /> Sprinklers <br /> TOTAL� � ��� � <br /> HYDRAULIC CALCULATION Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. . <br /> No. of Sprinklers: <br /> Total Water Required: GPM <br /> PERi'VIIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge. $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT F'EE (Add lines 1-3 above) $ <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees to <br /> do all work in strict accordance with the ordinances of the City and State re�ulations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> Applicant - Date � ��-�—L� <br /> YC�iC 7�C}C . . . . � <br /> ��=k.1�. . .���k�k���k�k�F���k�����k�k�k���k�k�k�kX������kh�xiex$cxxs;c��;c�e3c$c�c3c�cicx�c3,cx�e$e�;c3,ci,ea;e$e�kxe�cie�c3,c$c3�i,c$e <br /> Approved � Approved with Corrections Denied <br /> Reviewed b �, <br /> � �'l� '� �� Date _ �'�� �(� <br />