Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
. <br /> � <br /> Please check one: Ne�v� Addition Limited Energy Technolo�y <br /> Systems License # <br /> JOB SITE D C� � /Ltt �L� <br /> Owner's Name � I L.d�61 J�'Yl) , ( `1/�k� /} Telephone Number <br /> Mailing Address �3 Q � �j�p�Qct,C.�� P�.,�� <br /> Sprinkler Contractor's Name Telephone Ntunber�!,�,���41/•-113�j <br /> �. <br /> Contact Person � <br /> Mailing Address � �¢ G (1tJ � <br /> `VATER SUPPLY <br /> Lake Well_� City �� SQ���-C <br /> BACKFLO`V DEVICE <br /> AVB PVB � <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers ��'S.R. <br /> TOTAL <br /> I�YDRA.ULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: 2!6 a .�� � GPM <br /> . <br /> PERNII"I' FEE CALCULATION <br /> 1. Permit Fee $ 3�.00 <br /> 2. State SurcharQe � .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. 'I'O�'A�PERIv'II'I' FEE (Add lines 1-3 above) $ <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, ajrees to do <br /> all�vork 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 conect. <br /> Applicant �.t... .. . Date � '3 G ' � � <br /> ******x****�*** ***�*x�*�*�x****�***����**�*�***��*******�*�***�********�********* <br /> Approved Approved�vith Corrections Denied <br /> c " � <br /> Revie�,ved By: /�� �Q Date � o��T''� <br /> o— <br />