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Please check one: � New . Addition - <br /> JOB SITB a(o$D �rlverllic�J � �ri� <br /> Owner's Name ���y nlorr�s o� Telephone Number y�5-9a38 <br /> Mailing Address �- 6� S�/uer �ew � d.1r��� - <br /> Sprinkler Contractor's Name �en�4a�eS s�rlh�'ItC Cn. Telephone Number 9�9-I a 3 a <br /> Contact Person J o��► Gefscl� <br /> Mailing Address 61O(� �xc�sror ,Bl�rc�. �� sf . Locc�s P�rk', n9N S,� y�l � <br /> ****::*�:****:��*�*:*�:***:******:**::*****#�*:��****�*:***�::*#*,�*�**��**# <br /> CLASSIFIGATION OF OCCQPANCIBS <br /> Commercial Residential �_ <br /> t******:::*�***:***:**�*#tt*:****:******t*#*:*:****:**:***:#***:**:�:�***** <br /> WATffit SIIPPLY <br /> Lake Well � City <br /> �*****�***�*****�**�****** #***t***:#:*:**t**:*�r**:*******�*******t*:**:*** <br /> Year of Orifice <br /> Make Mode 1 Manufacture Size uantit <br /> rin ers p�to O 3 Pr►� <br /> 00 P � <br /> TOTAL <br /> ******:*****�*******�r***************�*************�****�**:**�*******�***** <br /> HYDRAIILIC�CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Cdverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: � 4 q GPM. <br /> �r***::****************�**:**��*�************t****��**�*:**#******:******:** <br /> Pffi21rIIT FSE CALCIILATION <br /> 1. Permit Fee $ 30.00 <br /> 2. State Surcharge. Based on valuation. $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PFRPIIT F:�B add lines 1-3 above $ <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 - Date - - <br /> ****************** ******** ********************************************** <br /> Approved Approved with Corrections Denied <br />; Reviewed y• <br /> ... Z���/ <br /> a� � Date <br />