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�/ �'3�7 <br /> t' <br /> Please check one: New Addition �_ <br /> JOB SITE ����0 Sf1�9 t��- �J�� Rn��I D�o•✓� <br /> . <br /> Owner's Name 1�; // O�c �� Telephone Number c�� -b8a-y� <br /> Mailing Address ���� �H•� s-w� �� D iP.✓��QZ s.� �7' <br /> Sprinkler Contractor's Name�it�'�� •9csFr 5��..-��-Cv- Telephone Number 9�'i--��3-� <br /> Contact Person ��1� �, G' �-Fs<< <br /> Mailing Address fd�'�-�, l a,..,G�y� ds� Sf�P�-� , S�. �o��r �Qr!F .t..� �'s?{�' <br /> . <br /> WATER SUPPLY <br /> �e � Well City <br /> BACKFLOW DEVICE <br /> AVB PVB RPZ <br /> Year of <br /> Make Model Manufacture Quantitv <br /> Sprinklers 7'o,Rv 60� 9 <br /> _' �� s �o �Q s� 4� <br /> 1�0'rAL 6 � <br /> gyDRAULIC CALCULATIONS Design Data: <br /> Area of Application: 3D ov v Sq. Ft. <br /> Coverage per Sprinkler: �20 o Sq. Ft. <br /> No. of Sprinklers: G �`- <br /> Total Water Required: ��/ GPM <br /> pERMIT FEE CALCULATION $ 35.00 <br /> 1. Permit Fee $ .50 <br /> 2. State Surcharge. $ 1.50 <br /> 3. Mail-In Fee $ �S sv <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) <br /> The undersigned hereby applies to the City for issuance of a Sprixilcler System Permit, agrees <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> Applicant � �!�� Date �-�3-r3 <br /> *�******* ************************��***********�***************************** <br /> Approved �/ Approved with Corrections Denied <br /> Reviewed y• ��. � <br /> Date <br />