Laserfiche WebLink
� , . <br /> Please check one: New � Addition <br /> JOB srrE y�,D ��ss e--� G�t �1 � <br /> Owner's Name �!ti'�'� �i L.t�Y►'��yl� Telephone Number �l�S -�� <br /> Mailing Address � 5 .Sp� � ;LC (Z' � <br /> Sprinkler Contractor's Name prz�5n� 5��r�k-�� Telephone Number `�� Z'�`���I <br /> Contact Person � � ���'��_ <br /> Mailing Address �-=�-� ����/ < �- <<D�(� /�1�� 5���6 " <br /> WATER SUPPLY � <br /> Lake Well � City <br /> BACKFLOW DEVICE ��---- (��Q, �� <br /> AVB C PVB � RPZ <br /> Year of <br /> Make Model Manufacture Quantitv <br /> �rinklers �� �?O �S (� _ <br /> � `1"�1�� ��/V� � J _ � <br /> 1 lJ 1 L-il� ( � <br /> HYDRAULIC CALCULATIONS Design Data: �(� <br /> Area of Application: -ti- �EJ c����`'���` 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� $ .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 <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> Applicant Date � t��-� <br /> ************�** ******��**�**�*x�***********�********x�***x�************x�*****�*� <br /> Approved Approved with Corrections �_ Denied <br /> Reviewed by• <br /> � Date �-��_ �_ <br /> '��7/ <br /> � <br />