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Please check one: New J/ Addition <br /> JOB SITE <br /> Owner's Name ��� ,,,'<<,,,� ��s Telephone Number yogi_ �v <br /> Mailing Address <br /> Sprinkler Contractor's Name � :.,( �rv,� Telephone Number 5+)q <br /> Contact Personf �!r J, <br /> Mailing Address /..1 /yam,,; ��. /y/.,,,/� pblf;,, <br /> WATER SUPPLY <br /> Lake Well —1Z City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers 044 PGP 97 <br /> TOTAL �9 <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: _y <br /> Total Water Required: 7,3' 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 <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 Approved with Corrections Denied <br /> Reviewed by: <br /> Date �,2 q� <br />