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► , <br /> Please check one: New_�� Addition Limited Energy Technology <br /> Systems License # <br /> JOB SITE ���� �.,�� ;s.`- � t � � � <br /> Owner's Name���,,c�. w �-�c� �.� �1.,,,�s �`''�Telephone Number <br /> Mailing Address <br /> Sprinkler Contractor's Name ��t�c���.,r /�1 r�� �� Telephone Numbe�a�5 /- 7 7�- 7a/,S-Q <br /> Contact Person l^'� .���rt ���-� <br /> c <br /> Mailing Address � / S�"'S S�`�-��,� �, �'7 !�'I•�-,p�c��:,��� � �-•,,� j S /�`�� <br /> WATER SUPPLY <br /> Lake Well City� <br /> BACKFLOW DEVICE <br /> AVB PVB� <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers <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 /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ �� l�G o <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ �— <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � s, �� <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees to do <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 are complete, true and correct. <br /> Applicant,�,i,,,, ���'� Date � �� G �j <br /> ********************************************************************************* <br /> Approved Approved with Corrections D�� <br /> Reviewed By: Date <br />