Laserfiche WebLink
Please check one: New Addition Limited Energy Technology <br /> Systems License# <br /> JOB SITE <br /> Owner's Name i yTelep <br /> hone Numberq S,7-5/7/—A 5 <br /> Mailing Address 65 Wd4t L <br /> Sprinkler Contractor's Name Telephone Number <br /> Contact Person <br /> Mailing Address <br /> WATER SUPPLY ,� <br /> Lake Well 1/ City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Ouantit <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 $ .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 ���(J� <br /> Approved Approved with Corrections Denied <br /> Reviewed By: /'!n/`�r�-�' Date / 0 -/O O� <br />