Laserfiche WebLink
h �i <br /> ' �'��`.'`;..�i"'�a�F�.� <br /> � <br /> Please check one: New x Addition <br /> '_��=.� !J 3 `?f�(`� <br /> Jos srrE S 5 S C-tSS e C ��►����o�vo <br /> � � �.3- �S o�s- <br /> Owner's Name c�n, �/ e � �.6 Telephone Number! � /� <br /> Mailing Address L U � S /�� �� -- �S� <br /> Sprinkler Contract r's Name r�t�s S e/��.i�.e, r� T honeNumber 7�� " G��f'�?-�2 <br /> Contact Person r-i a � / — C e l - (.� l� _ a �� sys� <br /> Mailing Address Svo � �a � �' � � l� C�/� Q 4 -�c� /� �I, �S�/J <br /> WATER SUPPLY <br /> Lake Well_� City <br /> BACKFLOW DEVICE <br /> � AVB PVB� <br /> Year of <br /> Make MT del Manufacture uanti <br /> Sprinklers �{t,h�- ��o 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 Surcharse $ .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 ap ' ation a complete, true and correct. <br /> Applican /t � Date � � � <br /> ************************ ******************************************************* <br /> Approved Approved with Conections Denied <br /> Revi wed by: <br /> � ' � Date �"��� � <br /> � �.��C .S ✓j� �'V KP�� !J vd- c/� .S P��'l al f Pq.� � <br />