Laserfiche WebLink
Please check one: New Addition Limited Energy Technology <br /> Systems License# <br /> JOB SITE <br /> Owner's Name c( � I .'►1/S telephone Number <br /> Mailing Address CD /S 4ja f c r �c .,n 11 d!u•�t Z, <br /> Sprinkler Contractor's Name seTV(c cZ '(l Telephone NumberContactPerson 6r 1 cL a <br /> Mailing Address vo G t <br /> WATER SUPPLY <br /> Lake Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make ModelManufacture Quantity <br /> Sprinklers ' c 4r L )0 0-3 l_Q <br /> TOTAL —S— <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq.Gb0 Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: S <br /> Total Water Required: NO GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharize $ .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 Q� <br /> Approved ` Approved with Corrections Denied <br /> Reviewed By: �a Date- <br /> -* <br /> ate- Need �-:r,c,N fir-, r.0�r}-,,� <br />