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�'../l G,J, � <br /> .� <br /> Please check one: New� Addition Limited Energy Technology � <br /> ystems License# <br /> JOB SITE 2U <br /> Owner's Name Te hone Number <br /> Mailing Address G <br /> Sprinkler Contractor's me . Telephone Numbery,3 ,Z—f'�,//—//�� <br /> Contact Person <br /> g � ' ss'�� <br /> Mailin Address �Q <br /> . � <br /> WATER SUPPLY <br /> Lake Well�_ City� <br /> BACKFLOW D VICE <br /> AVB PVB <br /> Year of <br /> a�� — Model Manufacture uantit <br /> Sprinklers �,�� ��3 � <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 /> l. 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 _ D�e /y� � �D y <br /> -o <br /> ************�****************�****�*�**********************�****************�**** <br /> Approved / � App v d with Coirections Denied <br /> /�� � � ` , <br /> Reviewed By: `1.�� '�'�''�'� Date � � ��\ <br /> _ <br /> -: _ i���, �, .,�sp��-�.. ��n� _���p��.,� _. _ : - _ _ _ <br />