Laserfiche WebLink
Please check one: New � Addition <br /> JOB SITE � � � � <br /> Owner's Name �rr� tY'c r�,�vS E Telephone Number <br /> Mailing Address V' <br /> Sprink.ler Contractor's Name g5i � �t'rr��Telephone Number Z��f <br /> Contact Person ���t�21.� <br /> Mailing Address ��{'7� Z'��' �}-< <�i.��'��'r� • <br /> WAT�K�' PLY - <br /> � Lake` Well City 1 <br /> � <br /> BACKFLOW DEVICE �r' I f <br /> .:° <br /> AVB PVB . <br /> Year of <br /> Make Model Manufacture Ouantit� <br /> Sprinklers `tJRO S'��� �7 � <br /> � '�v�.t> 57 a Z� <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 City and State regulations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> Applicant Date �cZ,�'�� <br /> x�x��x��xx*�x�x����� �����x��x��*��x�x��x�x�*x����x��x�x����x���x�x�x:���a�x��x�x�x���*���X���**x������ <br /> Approved Approved with Corrections Denied <br /> Reviewed by: r � l - <br /> � , <br /> . �' Date ��`� ,`� <br />