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i' i i J_,(.'h�� <br /> Please check ane: �/ew Addition <br /> JGB Sl:TE � C �f C� S Gl C� V � �'� �l��," P <br /> -, '�- 02� <br /> Owrier' s Name p�• t/O �� ��tq E E1�'�N Telephone Number t�7 � ` � <br /> � ��;�� ;�:�, t <br /> Mailing Address ,�� `��� ��1�' tJ � r/`� � ` �� '�'�� - <br /> Sprinkler Contractor' s Name / f?cr2 �0 /7 . Telephone Number S3�� G Y�3 <br /> Contact Person ����t <br /> Mailir. <br /> g Address 'j � '3� � L✓�1 KPL��4�'t� /'� ✓f� �e'Z�hfklL f''I?l�l• 'S J �� <br /> ****��**�************�*t******�*********************�* ****** *******#****� <br /> CI�ASSIFICATION f�F OCCQPANCIES . / <br /> Commercial Residential (/ <br /> *��****t#�*t********�****�t******t***�*****t*�*�**t**�****�**�**�*t*****�** <br /> WATER SIIPPLY <br /> Lake Well ✓� City <br /> *************t***�****�t***�*************�*****�*********f**#****�********�� <br /> Year of Orifice <br /> Make Model Manufacture Size uantit <br /> Sarinkler - <br /> L- � �-��v <br /> TOTAL <br /> #***�xt**��*�**�**��t*�t**����t**f*******f**#t��r****�**�r�*��**�*�**�*�**�****�* <br /> �Y"i��AIILIC CA.LCi7I.13TIONS Design Data: <br /> Area of Applicatior_: !�Y CJtT'� Sq. Ft. <br /> Coverage per Sprinkler: �� Sq. Ft. <br /> No. of SprinkZers:?� <br /> Total Water Required: ;�) GP"�• <br /> ***�t**t**�*******�***t��t****�****�:**�t***�*t***********�**���***�*��*�t�**** <br /> P ? IT FEE CALCIII,ATION <br /> 1 . Per�it Fee $ 30 . OQ <br /> 2 . State Surcharge. Based on valuatior. < $ .50 <br /> 3 . Mail-In Fee <br /> $ � . 50 <br /> 4 . TOTAL PERI�iIT FEE add lines 1-3 above $ 3�� C� <br /> The undersigned 'nereby applies to the City o� issuance of a Sprinkler <br /> System Permit, agrees to do all work in strict accordance with the <br /> ordinances of tne City and State reguZations, and certifies that all <br /> statements made on this application are complete, true and correct. <br /> t � <br /> A licant Date � / �� � `� <br /> �*************�***PP******** ** * * **�**** *****�******************� <br /> �pproved Approved with Corrections Denied <br /> �eviewed by: �j � l <br /> �-���� � �.�. <br /> Date <br /> l <br />