Laserfiche WebLink
Please check one: New Addition Limited Energy Technology <br /> Systems License# '�"'crj0� 3g� <br /> JOB SITE ��%' " �J '�S �� �� <br /> `..�- • <br /> Owner's Name 1/' ,,,5' Telephone Number � /a '�9-0���Z <br /> . <br /> Mailing Address , <br /> Sprinkler Contractor's Name � ��Telephone Number ,6 j-6�`T��� <br /> Contact Person <br /> Mailing Address p D ��� R /(� . � �yf/, <br /> WATER SUPPLY <br /> Lake Well� City <br /> BACKFLOW DEVICE <br /> AVB PVB� <br /> Year of <br /> ke • del Manufacture uanti <br /> Sprinklers � Q �'P/� <br /> / G'Pr�+ <br /> � 6�'� <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 /> � — <br /> PERMIT FEE CALCULATION <br /> l. Permit Fee $ 35.00 <br /> 2. State Surcharee $ .50 � <br /> 3. Mail-In Fee $ �— <br /> 4. TOTALPERMIT FEE (Add lines 1-3 above) $ p <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit,a��to d� <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 re complete,true and correct. <br /> . <br /> Applicant D� <br /> ********** *************** ***************************** *******� e********** <br /> Approved �� Approved with Corrections Denied <br /> Reviewed By: ������ � Date �-��-�� <br /> r, � �: �z1r ���� �� <br /> � t��h tr��: <br /> �.„ �� ii'�h.��t� \�h mk. •.s�Z�'i�.�tk�u�u'. <br />