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1 <br /> Please check one: New Addition <br /> JOB SITE <br /> Owner's Name�!/i � �� Telephone Number — <br /> MailingAddress <br /> Sprinkler Contractor's Name ��`��� <br /> , T .� Telephone Numbe44 yfi <br /> Contact Person St s <br /> Mailing Address_ 9v9-A _ <br /> WATER SUPPLY <br /> Lake Well City <br /> 'BACEFLOW DEVICE <br /> AVB PVB , <br /> Year of <br /> SRrinklers <br /> t• <br /> r. <br /> Ity <br /> HYDRAULIC CALCULATIONS Design-Data: <br /> Area of Application: d 4 Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. , <br /> No. of Sprinklers: <br /> Total Water Required: GPM <br /> PFMM FEE C LCUI,AnON <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 /> Applicant Date g <br /> (71!p <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> Date <br />