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, <br /> � <br /> u � `�`� � <br /> Please check one: New� Addition <br /> JOB STTE_�'��e O �I1QC��i►�,'dUcl lLt� <br /> Owner's Name ��� TelephoneNumber'IC�Q-�{Q�'-�,�j;P' <br /> Mailing Address�'��� Cr�� G,n��.:� <br /> Sprinkler Contractor's Name � •�l�f�,�TelephoneNumber�(�3-�'�C� ����� <br /> Contact Person v t � e� <br /> Mailing Address"_511`_� ��b.��,,�� •`� � f� it�iv �1�`r� 1Y1� �j�:�`� . <br /> �VATER SUPP Y <br /> L�� u'ell City <br /> BACKFLOW DEVICE ��.A. <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers _ 1- c� wliin�tr �00� ��(� <br /> r <br /> TOTAL 30 <br /> HYDRAULIC CALCITLATIONS Design Data: <br /> Area ofApplication: �—? ,�o� Sq. Ft. <br /> Coverage per Sprinkler: / �+��D Sq. Ft. <br /> No. of Sprinklers: � � <br /> Total Water Required: ,��f Gp� <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) $ �-j ��� <br /> The undersi�ned hereby applies to the City for issuance of a Sprinkler System Pernut, 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��j <br /> ************************ ****************************�************************** <br /> Approved � -- Approved with Corrections Denied <br /> Reviewed by: <br /> - ����,c ��� Date �°—/C� � <br />