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Please check one: _ _New Addition��-�� <br /> JOB SITE S/5" 0 n/ K A-yclA 4e>AJ r0960(7 <br /> Owner' s Name T.A/SE,�I YTi�M,!t S Telephone Number <br /> Mailing Address <br /> Sprinkler Contractor' s NameTelephone Number <br /> Contact Person <br /> Mailing Address <br /> CLASSIFICATION OF OCCUPANCIES <br /> Commercial Residential <br /> WATER SUPPLY <br /> Lake Well City <br /> Year of Orifice <br /> Make Model Manufacture Size Quantity <br /> Sprinklers <br /> �f 512C) <br /> TOTAL 2 <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: �� - �3 Arc kz— Sq. Ft. <br /> Coverage per Sprinkler: e Sq. Ft. <br /> No. of Sprinklers : <br /> Total Water Required: GPM., 41©42- <br /> PERMIT FEE CALCULATION <br /> 1 . Permit Fee $ 30 . 00 <br /> 2. State Surcharge. Based on valuation. $ .50 <br /> 3. Mail-In Fee $ 1. 50 <br /> 4 . TOTAL PERMIT FEE add lines 1-3 above $ =' !O <br /> The undersigned hereby applies to the City of issuance of a Sprinkler <br /> System 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 /,/ 1 - Date �of <br /> Approved 't,,/ Approved with Corrections Denied <br /> Reviewed/(by: <br /> -1 - 30 -90 <br /> Date <br /> SyST'C`m 0csi 6.v es o^.N s %TE — joCSi6N 5CAeeS 40 PAbu ia-Q <br />