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?L <br /> f <br /> Please check one: New Addition Limited Energy Technology <br /> Systems License # <br /> JOB SITE RWQ <br /> Owner's Name J ee bee _ Telephone Number?,5D-49/- a ?`i S <br /> Mailing Address 960 0 /,Y?/(-) : <br /> Sprinkler Contractor's Name /;�i C Q,�(Iyl �2, Telephone Number 9J�a` 16 -17ys <br /> Contact Perso o»-� <br /> MailingAddress3)70 <br /> WATER SUPPLY <br /> Lake ,Z,- Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantit <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: <br /> Total Water Required: GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge <br /> $ .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 Date 61W0,5- <br /> Approved <br /> p o2 0j-Approved ! Approved with Corrections Denied <br /> Reviewed By: � Date..6 - <br />