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t <br /> Please check one: New Addition Limited Energy Technology <br /> Systems License # <br /> JOB SITE <br /> Owner's Name /� f-h�,., /�r n v ! C-4 Telephone Number 515"z -9 Z y- Vs-s�"' <br /> Mailing Address 1375- L/, i e P L 01 G /;,ti <br /> Sprinkler Contractor's Name fix-c, j s��e h� s�� Telephone Number -76?, yy7. yc/y3 <br /> Contact Person =e Z ;76:3 <br /> Mailing Address S 3 Veep Q v r S-r, r,; CA 4e- j /y,,, <br /> SI'>7.c <br /> WATER SUPPLY <br /> Lake ✓ Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Ouand <br /> Sprinklers Nom.,, PGP R�,o�f 2 <br /> q A _ <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: j Z, /OU Sq. Ft. <br /> Coverage per Sprinkler: Z o 2-�r L 2 Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: 2, GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 35 ('0 <br /> 2. State Surcharge $ .50 <br /> 3. Mail-In Fee $ <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 37 <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 /> _.. <br /> Applicant Date 0? <br /> Approved Approved with Corrections Denied <br /> Reviewed By: F Date- 7—q-07 <br />