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. . .___ . .. .... _ <br /> Please check one: �ew : Addition - <br /> . , - /�o� �t�nl f fi���hl' �' `> f <br /> �JOB SITS �r <br /> Owner's Name L/� rr� rrt � �f" �'�. Telephone Number - <br /> Mailing Address <br /> Sprinkler Contractor's Name / ���� �r �.{''(`. Telephone Number °/- S� <br /> Contact Person v f. Y"�1U0. <br /> Mailing Address �6���� �1�3v�C�e'r ���� 1 'L Q rvr, rs , �_5;��/� <br /> ����t��������������t�t��������t��t�t������������������:*:*::�:�**:****:#*:* <br /> CLASSIFICATION OF OCCQPANC]C$S <br /> Commercial Residential J� <br /> �******:*�**:*�:*:*:*****:��*�t****:*****�***�t***:�***��*:**::*#*:�*****:* <br /> WATER SIIPPLY <br /> Lake Well City <br /> ******:****::**:*****t:*�*�r�i:::**:*�*:**: ***:**:***:*:*****:*****�r******,r* <br /> Year of Orifice <br /> Make Mod�l Manufacture Size Quantity <br /> prin ers a;.►B;'r / -�'i5'�� �. r �7 <br /> � <br /> TOTAL <br /> �**********#:********�***�********�**�*****�******#t**s�**t�**�************ <br /> HYDRADLIC CALCIILATIONS D�esign Data: <br /> Area of Application:��p Sq. Ft. <br /> Cdverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: /� GPM. <br /> :***#*�*�*:******:********::***�***:*************#�*************�*:*:*�***� <br /> PBR1riIT FES CALCIILATION <br /> 1. Permit Fee $ 30.00 <br /> 2. State Surcharge. Based on valuation. $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEB 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 /> Applican Date � f `� <br /> *************************************************************************** <br /> Approved Approved with Corrections Denied <br />. Reviewed : <br /> ._ � q_�- _� 1 <br /> Date <br />