Laserfiche WebLink
11 <br /> /d ' <br /> Please check one: New )( Addition <br /> JOB SITE ;3-q6C G� r <br /> Owner's Name 0-e- L) (_,/v eP' Telephone Number 4/69 --al eZ <br /> Mailing Address S-7 S .SCr s s- y <br /> Sprinkler Contractor's Name 74thrt, s r c-r -�tr- Telephone Number 6',1"-C— 02/7_2_ <br /> Contact Person r \ a <br /> Mailing Address CSV u / Ti r 1 / - <br /> WATER SUPPLY <br /> Lake Well >( City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers /-�µv' �1� - y o <br /> if P <br /> TOTAL '7 <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: �1 5(._)0_, Sq. Ft. <br /> Coverage per Sprinkler: /72S Sq. Ft. <br /> No. of Sprinklers: £/S <br /> Total Water Required: / S 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 o •inances of the City and State regulations, and certifies <br /> that all statements made o is a i . ion are complete, true and correct. <br /> Applicant I Date `) <br /> 11 <br /> 11 <br /> Approved Approved with Corrections Denied <br /> Reviewed by.i Q FicieDate U �� <br />