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_ _ � � � � <br /> F�ease check one: �New Addition � � <br /> � <br /> JOB SITE � � � ' � �V4 J�l't_� l�e� y <br /> Owner's Name �, �y�(Telephone Number �?j-S .�S <br /> Mailing Address <br /> G�r� , � . r�r� -dZ g <br /> Sprinkler Contractor's Name ���,rc,R�—Lt,�� Telephone Number <br /> Contact Person_�C �(S <br /> Mailing Address C'3 � � �S � ���� <br /> �*��************ ********t*�** **��:******t **** :*** ****:*********#***** <br /> CLASSIFICATION OF OCCUPANCIES <br /> Commercial Residential <br /> *tf**##*********:********�*:�******::�******:#t************#**t********t*t� <br /> WATER SIIPPLY <br /> Lake Well City <br /> :****�*******�*�*****#*�*�*********************:************�*���**�***:*** <br /> Year of Orifice <br /> ke de Manufa t re Size uantit <br /> rinklers � <br /> TOTAL <br /> *****************t**#**�****��*************�********#****#******����******* <br /> HYDRADLIC CALCIILATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers : <br /> Total Water Required: GPM. <br /> **************#******tt*****************�********************************** <br /> P�IIT FEE CALCIILATION <br /> l. Permit Fee $ 30. 00 <br /> 2. State Surcharge. Based on valuation. $ .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 of issuance of a Sprinkler <br /> System Permit, agrees to do all work in strict accordance with the <br /> ordinances of the City and State regulations, and certifies that all <br /> statements made on this application are complete, true and correct. <br /> Applicant _ Date / 5��� <br /> ***************************** ********************************************* <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> _ �t. ./ `��1 `�/ � <br /> Date <br /> � <br /> i <br />