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' . � C�D� t90��?�1 <br /> 1�� s� <br /> ��s i <br /> Please check one: New �•/ Addition Limited Energy Technology <br /> Systems License # <br /> JOB SITE /(o�l U ��� c-� , u/✓7��'t� yY� <br /> Owner's Name Q�yrtC�v �^ Telephone Number <br /> � , <br /> MailingAddress � � � "�� ,��t � �} )� � <br /> SprinklerContractor'sName /��7-,n�,� �ia�:�� �n�,,�,k�'o;�< TelephoneNumber 9� - ��6•-,/ 77� <br /> Contact Persor� ' �;�0�-� � ' <br /> MailingAddress � �� �i �Q�,� ' ���� - /� ,�nti 0��)I(,�f r"` �� <br /> WATER SUPPLY <br /> Lake ✓ Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers <br /> R g.�,� �.� n � �b--� <br /> � r� l Fsla <br /> � ��.,es� PG-� - B �S � G-�-oy <br /> TOTAL��_� <br /> � <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 Surcharae $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ '3 S,S� <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 conect. <br /> Applicant `� �,O�� �' Date � � 0�� <br /> ******�*********��****�****x�*` *******�****�**************************�x********* <br /> / <br /> Approved v Approved with Corrections Derued <br /> Reviewed By: ���'��,� ''���%� Date - -Q� <br />