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Please check one: New Addition <br /> JOB SITE U •� 4 rc.0 - <br /> Owner's Name As ��M �,l Telephone Number <br /> Mailing Address <br /> Sprinkler Contractor's Name G�„�rtS Telephone Number <br /> Contact Person j.,,.)e <br /> Mailing Address l�c /-yj,�,,., �'�[ /�..��� �.�►.. <br /> WATER SUPPLY <br /> / I <br /> Lake Well // City <br /> i <br /> BACKFLOW DEVICE <br /> AVB PVBy` <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers <br /> TOTAL — <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. "%. <br /> No. of Sprinklers: �S <br /> Total Water Required: �,�- GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharee. $ 50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> i <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees to <br /> do all work in strict accordance with the ordinances of the City and State regulations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> i <br /> . I <br /> �\ Applicant Date <br /> ry, i <br /> Approved Approved with Corrections Denied <br /> Reviewed b <br /> Date <br />