Laserfiche WebLink
. ._ =. ���3 <br /> � , � <br /> Pleasc chcck onc: Ncw � Addition <br /> JaB sz� <br /> Ownez's Nasne �� �l�s�.iB��HE� Te�e�hone Numher <br /> Mailing Address _,�?C��/o, '���.�r�cvc�n D2 — <br /> Sprinklcr Contractor's Name (�/1t����_�' 1�'/GA'Ta.Telephone Number •73 f-a0lo� <br /> Contact Person ' oa �' <br /> /fuosc�.J oao �c.2 x� 6�Si�S <br /> Mailing Address �a 5Z� � <br /> WA'TER SYJPP�Y, � <br /> Lakc Well City � <br /> BACKFLO�.�sVICE <br /> avB �vB X �z <br /> Year uf <br /> Make Mc�del Manufactiire .. (�uant' <br /> S . . .ers Toza S�To /9 93 �s <br /> ��Q..�xcc.� c�,�� 5- �0 9 S 3 � <br /> �J �v JCHD a�az% t�l 1'� <br /> L'o.vricuc.� �:-•;;� —; �!� P,2.�.: i 9 9 3_ <br /> 'PQrTAL <br /> T�y;;;��t„ rr• rALCULATIQNS Design Data: <br /> Arca of Appaication: � Sq. F�. <br /> Coverage ger Sprinkler; , �q- F�' <br /> No. of Sprinkiers: GPM <br /> Total Water Required: �� — — <br /> PERiMTT FE� CA��U[.ATI N $ . 3�.00 <br /> l. Pemnic Fee $ .5Q <br /> 2. �tat�Surcha�ge• $ 1.50 <br /> 3, Maii-In Fee $ _��� <br /> q. TOTAL PERIV��T I+TE (Ad�i li�aes t-3 ahove) <br /> The undez'signed hereby ap�lies to the Cicy for issua��c� ot a Sprinkler System Permit, flgrees <br /> to da all work in strict accordance with che ordis�anccs of t�ze City and State re�ulatiox�s, and <br /> certi�es that ali statements made on this application are completc, trtac an.d correct. <br /> � Applicant . Date ll— —9.� <br /> ***�*************�****�x�**** *******�******���**»�***�*�*******�«****�,��*�«**** <br /> Ap�roved �� Approved with Correctians� Denied <br /> Reviewed , �� <br /> Date .� <br />