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1 <br /> Please check one: New XAddition <br /> JOB SITE <br /> Owner's Name tic zTelephone Number <br /> Mailing Address <br /> Sprinkler ContractKx <br /> ' Name A2 STelephone Number <br /> Contact Person1 <br /> Mailing Address n 0 AV,U <br /> WATER SUPPLY <br /> Lake Well City <br /> BACKFLOW DEVICE <br /> AVB PVB RPZ <br /> Year of <br /> Make Model Manufacture Quantity <br /> S rinklers <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Desi F/� <br /> ata: <br /> Area of Application: � Sq. Ft. <br /> Coverage per Sprinkler: 2-6() _I;Q. =�d Sq. Ft. <br /> No. of Sprinklers: ® r <br /> Total Water Required: 1 a Pr Onn GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharize. $ .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 <br /> Approved Approved with Corrections Denied <br /> Reviewed b <br /> Date <br />