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s� lrj!/0 j <br /> ��"; . <br /> � � <br /> Please check one: New � Addition <br /> JOB SITE o�! �.T � �o�•s �f �h. <br /> Owner's Name �o� ,���,�,' Telephone Number <br /> Mailing Address �q 7 � Sor--��r��f �,., . �'�ro r, <br /> �� <br /> Sprinkler Contractor's Name Gc►�r../ � �c,�N� Telephone Number �r��-a2,S8� <br /> F--- <br /> Contact Person =�r���r•-,� e_ <br /> Mailing Address �/�,s j"Y�.:, d� 11�,-�/c 1.,,:, <br /> WATER SUPPLY <br /> Lake Well � City <br /> BACKFLOW DEVICE <br /> AVB PVB ✓ <br /> Year of <br /> Make Model Manufacture Ouantit,� <br /> Sprinklers ^�.�� - ��� �'18 �7 <br /> TOTAL �'�7 <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: /f'- /� GPM <br /> PERMIT FEE CALCULATION <br /> l. 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 Ciry and State regulations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> ( � - - � <br /> Applicant � Date "o?.�- `�� <br /> *�***�** ***** ********�*********************��x**�****�***x�******�********� <br /> Approved L- Approved with Corrections Denied <br /> Reviewed by: <br /> Date g /3� �q� <br />