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' ,s„ <br /> Please check one: New Addition � . <br /> r�� <br /> JOB SITE ��� (�i ��2�' ��r'D '�, ;'a �t�'l v'�. ` � <br /> � <br /> Owner's �7ame_��_;�}�EZ; .,�� �� C�-� Telephone Number �O -- � �S� <br /> Mailing Address (� 4 . . <br /> Sprinkler Contractor's Name c�t � -��r;, v�-, . Telephone Number�r//� <br /> � <br /> ,, , <br /> Contact Person C,' ��` <br /> Mailing Address � � � i _� � .� i.�,1�., ����, <br /> WATER SUPPLY �i`�4-/�.{ � <br /> Lake Well � City /1/� �,, <br /> srS',3 cl c� <br /> BACKFLOW DEVICE � <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Ouantit,� <br /> Sorinklers <br /> TOTAL <br /> HYDRAULIC CALCULATION Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. . <br /> No. of Sprinklers: <br /> Total Water Required: GPM <br /> PERi1�IIT 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 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 /> �' � . <br /> �, <br /> Applicant = --C -�--�-�--� Date <br /> � �" -�� ^j � <br /> �e�c=kycxie�c�k����k��k3��k3�xa;e�c�k���k��k��k��k�k��kX$�������xicacicxi,c3c�i,c�k3,c�c�K�c3,ei,cs;cac$c3,c�e;ca;e3,cxx3exXe�jeie�c3c3eaeac�(c <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> —� <br /> Date <br />