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Please check one: �New Additio D ��N`� n `��� � <br /> I � <br /> 4 � C�C�LC�Ot/ � �` � <br /> JOB SITE ���(�L �t?S'S Q-`,.� ��` <br /> �wrier' s Name /t-�� ���� w����C��� ` Telephone Number ' <br /> . _ _ ` — <br /> Mailing Address ���c`�� � � • <br /> �(� 1 <br /> Sprinkler Contractor' s Name �f����'�`{'` �s�"�'�Telephone Number �-17Z -�<<� <br /> �ontact Person �� i--�� <br /> Mailing Address ;�ti CC�-� � ���� �� �'"�� <br /> *�*******�******* ***�***�*******�*�***********************:*************�� <br /> CLASSIFICATION OF OCCIIPANCIES <br /> Commercial Residential �_ <br /> �****�*�**:*************�***�***�*#*�***t**t******�**�*****f**t*�*t�****�** <br /> WATER SIIPPLY <br /> Lake Well � City <br /> ******************�*******�* ***********��*****�*�***��*t****************** <br /> Year of Orifice <br /> Make Model Manufacture Size uantit <br /> Sprin lers -+-�,,2v 4-ir,�� 5 Z ;�-S��Q►�n ( <br /> TOTAL <br /> �#*****�*��*:r*****�******��***��**�*****�**�***#��**t*�***********:****t���t <br /> H`�DRAIILIC CALCIILATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: GPM• <br /> *�**��***t********t*******��******:********t**�*****�*******�************** <br /> PERMIT FEE CALCIILATION <br /> ; . Permit Fee $ 30.00 <br /> 2 . State Surcharge. Based on valuation. $ .50 <br /> 3 . Mail-In �ee $ 1.50 <br /> 4 . TOTAL PERMIT FEE add lines 1-3 above $ <br /> ^he undersigned hereby applies to the City of issuance of a Sprinkler <br /> �ystem Permit, agrees to do all work in strict accordance with the <br /> ordinances of the City and State regulations, and certifies that all <br /> statements made on this application are complete, true and correct. <br /> Applicant Date ' `� Z" <br /> ******************************* ***************************************** <br /> Approved Approved with Corrections Denied <br /> Reviewed , <br /> �� i�� ��f � � . <br /> Date <br />