Laserfiche WebLink
� � � <br /> Please check one: New � Addition � <br /> JOB s� ,�3v�v � Sor��.r-.s�t- �h . <br /> Owner's Name ��,�,.-�- �,r� _ Telephone Number yy y -�.?9 v <br /> Mailing Address �O�c� ►.-� .- ��..f ,L,n ����--,�� .�..� S-�2 �� , <br /> Sprinkler Contractor's Name �� �., ��G Telephone Number y�g _ a��� — <br /> Contact Person �.� �,., o �.. <br /> Mailing Address � /�� ��.,,.., j �� /?�,�/� �/��.h �r. .fs 3 S^1 <br /> WATER SUPPLY � <br /> Lake Well _� City <br /> BACKFLOW DEVICE <br /> AVB PVB � RPZ <br /> Year of <br /> Make Model Manufacture Quantitv <br /> Sprinklers ���.n �c� /�� t� � < �/l9 <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 Surcharge. $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT F'EE (Add lines 1-3 above) $ <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> Applicant Date �'���`�1�S� <br /> *�******�* **** *************���*********�*******�*�******�**�***��***�**** <br /> Approved � Approved with Corrections Denied <br /> Reviewed by: � <br /> Date <br /> � .� <br /> v <br />