Laserfiche WebLink
. � a�oy _�d 3�� <br /> � ; _ ��- oq <br /> Please check one: New x Addition Limited Energy Tec, ology <br /> Systems License# �L� 7 7�� - <br /> JOB SITE � �� � �� �q rq r. �-�J� c � t� �' <br /> Owner's Name�.S� �,� 2 i.�.:��l �• �S�J <br /> _ ' � ��c ����' ^.s Telephone Number <br /> MailingAddress � 1/� � �r���� ��� � � � �' . <br /> SprinklerContractor'sNameS:��e4 ; � !'� -c�. c���-�� P.�� TelephoneNumber 7C,�3 -t/�.� - '-/79( <br /> Contact Person 13; I J S�z, ��-�-�n���'o� <br /> Mailing Address �� � I �(.3 'j y �q � <br /> � /" • �E'c��.�y�, �f�-�� ,v,� v�S�y� <br /> WATER SUPPLY <br /> Lake Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers /L��n�c: �z �; - ��� ;:� <br /> � � �;c-• <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 $ 35.00 <br /> 2. State Surchar�e $ .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 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 � � Date ��:�-Z�� ( <br /> **********************************************************************�x********** <br /> Approved��- Approved with Corrections D�� <br /> Reviewed By: _�6�� o�� � Date �p.- � � ��,`�� <br />