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�f�3� � <br /> Please check one: �New Addition <br /> JOB SITE 7� 5r J ( ( UL� /�L�6� O�' 6,e�tid <br /> Owner' s Name �l �I/1 �G`�I �� Telephone Number �75� /Yd 2 <br /> Mailing Address 7j/� �'k ��� ���6G� Q�2 D�0'� � <br /> Sprinkler Contractor' s Name %/!r� ��-�/�� Telephone Number �75�^�y� � <br /> Contact Person .�� L <br /> Mailing Address �� <br /> �****:*�*:****�**********�****:�**�*********************:�:::*****�*:***�*� <br /> CLASSIFICATION OF OCCIIPANCI$S <br /> Commercial Residential � <br /> *�*******#**�***�********************�:*****:*�****:***:**::***:****�****** <br /> WATBR SIIPPLY <br /> Lake Well � City <br /> *:*********:***��:****�**��***�*********�*f***�***:*�********���*�**�***�*� <br /> Year of Orifice <br /> Make Model Manufacture Size uantit <br /> rin ers • <br /> �+�'�.ec'''�` g t R"k.- <br /> sY} � ��.�" /� �� i7 <br /> �� <br /> ****************************************�***********#**********�*********#* <br /> HYDRAIILIC GALCIILATIONS Design Data: <br /> Area ��f Applicati�n: �9 �'�� Sq. Fte <br /> Coverage per Sprinkler: �/d _ Sq. Ft. <br /> No. of Sprinklers: 2��_ <br /> Total Wate� Required: /Z. GPM. <br /> *�:*******�*��*****�***�*���*:***�******#*t#*��*:***�***********�*********� <br /> PB1tMIT FEE CALCDLATION <br /> 1. Permit Fee ' $ 30.00 <br /> 2. State Surcharge. Based on valuation. $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PFRMIT FB$ add lines 1-3 �bove $ 3/> •Sa <br /> The undersigned hereby applies to the City of issuance of a Sprinkler <br /> System Permit, agrees to do all work in strict accordance with the <br /> ordinances of the City and State regulations, and certifies that all <br /> statements made on this application are complete, true and correct. <br /> Applicant G��� Date ��-g��� <br /> ************ **************** ******************************************* <br /> Approved Approved with Corrections Denied <br /> Reviewe y• <br /> �d-��-�/ <br /> Date <br />