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Please check one: New Addition <br /> JOB SITE ,��c� %ro—!I re•� y� <br /> Owner's Name Telephone Number <br /> Mailing Address <br /> Sprinkler Contractor's Name �� I c-r-vYL.. Telephone Number ? <br /> Contact Person rri <br /> Mailing Address <br /> WATER SUPPLY <br /> Lake Well �� City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers ,_ �, ��w r ?� <br /> TOTAL ? <br /> HYDRAULIC CALC ATIONS. Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: /�S'" JJ' GPM <br /> PERiMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge., $ .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 <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 /> Applicanta <br /> `^ DateIlel <br /> ���x$ei,$ese��?k� .3�3��$ck�kk�kkk�=kkkk3KkkkX�Ckac�e�e$eaexac�c�tkk�k�3,c�cx3c$eacie$caeaexx>;c$e�;c3,eactc�cFac�c <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> Date K �� <br />