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... � <br /> . � ; � � � <br /> V � <br /> � <br /> Please check one: New /� Addition x <br /> JOB SITE /Z Z � ����. �"i�-�-� \-�c, <br /> Owner's Name �.�. � ,,,.�•�y u��-��__ Telephone Number <br /> Mailing Address ��{ ,�.,�.�• <br /> Sprinkler Contrac or's Name �l L,,,;„�,., ��( 1�,,,,.���,*,,tiTelephone Number �?Z,- l�C�l� <br /> Contact Person t `� � c � `��Y� ����` —��U� � <br /> �.,�� � ��� l/ X <br /> Mailing Address 5`7�5�'r �l1Y���.�k;: -� �� �-lo�,.�� l'��_. S s�4.� <br /> WATER SUPPLY <br /> Lake 1l Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Ouantit� <br /> S rinklers � `��� �'4�� c�7 �- ' <br /> l�cr• '� ��,z% c�y / � <br /> TOTAL <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 Surchar�e. $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees to <br /> do all work in strict accordance with the ordinances of the Ciry and State regulations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> 1 ,—� ����� �` � - �_ � ' t�� <br /> Applicant )atc <br /> x�x�*����x��x��x������x�����x�*��x�������������x*�x����x*����x���x�:�*��x�x�x��**��*���x�x*�x����x� <br /> � <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> J �� <br /> � :.�.r Date v�/ <br />