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� � <br /> � � <br /> Please check one: New � Addition � <br /> JOB SITE <br /> . Owner's Name C�jg/6 �-JI L L�� Telephone Number Sd- � ,3' y��� <br /> �� <br /> Mailing Address /3 d2 .S" .S/-f�q,p�'�,/,�/� j�/ YE <br /> Sprinkler Contractor's Name G��G/t//�j�EPL='f�SidG, Telephone Number 95.�-✓`�y`—o y� � <br /> Contact Person ���iY� �j//yd/IJS <br /> r;'S3 C�S`� <br /> Mailing Address vZ�3 s�l/J�d/E ro�r//�/� ��YGI /yl�/yE�rl'��;1� <br /> WATER SUPP Y ' <br /> Lake Well City <br /> BACKFLOW DEVICE /�o/y� <br /> AVB PVB RPZ <br /> Year of <br /> Make Model Manufacture Quantitv <br /> �rinklers �1�/I/�E'6' /°�P � <br /> �14/A'J Ig//LD �U�f / � <br /> . TOTAL _�'� <br /> HYDRAULIC CALCiTLATIONS Design Data: <br /> Area of Application: �../�I,v/� Sq. Ft. <br /> Coverage per Sprinkler: ,�S [�� Ou��ED Sq. Ft. <br /> No. of Sprinklers: ���u�R.�O <br /> Total Water Required: d� GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge. $ .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 <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and conect. <br /> Applicant �� ��� Date 7" � 3 � � <br /> **************�*************�*****x�******************************************* <br /> Approved Approved with Corrections Denied <br /> Reviewed by: --7 <br /> Date / r�� �� <br /> �'�� Neec� �.�\ ;�g��c�-;�� ���� �o������-cc� , <br />