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. ;�-�- � ���� � <br /> �. <br /> o�4 Please check one: New v Addition Limited Energy Technology <br /> i��,!' . ,�� Systems License # <br /> ,n� <br /> ;��r . <br /> JOB SITE��_�� , � -, ,•,Zr-_,-��'�� � �•� . <br /> Owner's Name �- �'Q,-�,�5��,:-t Telephone Number <br /> Mailing Address ���.�- � �.,��..r s� �- ,1, �:-i <br /> Sprinkler Contractor's Name�>� .-��:�,�(' . ���.�'elephone Number ��;,� - y� � ^�S� .3% <br /> Contact Person ��;�> � li��;� � ��1� -a ��� r �� <br /> -�.� <br /> Mailin Address . , �� ./` � '- 5;� z� ��J %J% ` � <br /> S � � � %,,<, �_ .�;�/� �t« �S�s� <br /> WATER SUPPLY <br /> Lake Well �City <br /> BACKFLOW DEVICE <br /> AVB PVB �" <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers ���. , -c_r ���'�-�- c.,�� �� <br /> /�� •,�; ::.�.,/ /�c� y �c.� �/ .:.t��, <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 $ �g-� <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �LL�`�. S C%' <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit,agrees to do <br /> all work in strict accordance with the ordinances of the City and State regulations, and certifies that <br /> all statements made on this application are complete, true and correct. <br /> Applicant �. Date , ��Z > � �/ <br /> �x*****�*�'*� **** ********�x**�******�x*****************�****�**�****x�********�**** <br /> � <br /> Approved /`^ � Approve with Corrections Denied <br /> (`� � ����_���fi <br /> Reviewed By: � �— Date <br /> _ . _ __ - - - <br /> _ _ _ _ _ <br /> _ _ _ _ _ _ __ <br /> _. ��� r�: ��S�tc.�-:•�-� ....1.c�: :�v,�P���� : : _ ._ - _ _ <br />