Laserfiche WebLink
. F �a,�,1�d., t��-- �I7/�D <br /> � � 0�009- oo�'�'o <br /> �-ir og <br /> Please check one: New � Addition Limited Energy Technology <br /> Systems License # <br /> JOB SITE <br /> Owner's Name�l1,�'�' y �"�.Js�t f l Telephone Number 37U• Z 20 ' �S'� <br /> MailingAddress 2,� �t; .�N� �!✓v�p ,�''6' <br /> Sprinkler Contractor's Name -�/��"`�1�r-°',�� �'`�t,�- Telephone Number .��"�` �'f{���,�'� / � <br /> Contact Person S�ea i'�7� <br /> r. ���� �+ <br /> Mailing Address -�/,j .��� � J <br /> WATER SUPPLY <br /> Lake�� Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers �s�s--�„�,�',� ,� S� y Z�a 9 S 2 <br /> �.�_4,,�.�✓r�i'�.�cz� i�� `� .21.� � / � <br /> �.��r BJ,� /rw� � 2va q // <br /> TOTAL_ g3� <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area ofApplication: 3�, oc�c� Sq. Ft. <br /> Coverage per Sprinkler: ,��'�(� Sq. Ft. <br /> No. of Sprinklers: �/ <br /> Total Water Required: l,� ,�i` GPM <br /> �r�'a�' ��?(' f�t� r`; <br /> PERMIT FEE CALCULATION <br /> l. Permit Fee � 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) � 35.50 <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees to da <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 /> Applicant Date <br /> ******************�************************************�************************ <br /> / <br /> Approved �� Approved with Corrections D�� <br /> Revie�ved B}�: ,/�,` � ,[J2.. Date_ �� !,�- Q� <br />