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f <br /> Please check one: New °� Addition <br /> JOB SITE 3 T ; , f <br /> Owner's Name Telephone Number <br /> Mailing Address 3� ��%` ��� e.�� ✓ -A <br /> Sprinkler Contractor's Name T//i � /��"r / � ' h Telephone Number�G-62 Y <br /> Contact Person he (GG l <br /> Mailing Address z, <br /> WATER SUPPLY <br /> Lake Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Malce Model Manufactureu <br /> Sprinklersloe <br /> GrrrJ l 1 /8Ga Send <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: (a :.)row 2, c1cve- .hI-)Sq. Ft. <br /> Coverage per Sprinkler: Clu s c Sq. Ft. <br /> No. of Sprinklers: -42r <br /> 2 6r (rU sPru� <br /> Total Water Required: S 3 a 12kvk GPMj�� <br /> l � �Q (1G��QV15 (7E?C �7P1iC.trP on <br /> PERMIT FEE CALCULATION J 0 <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 <br /> Approved OL Approved with Corrections Denied <br /> Reviewed by: <br /> Date <br />