Laserfiche WebLink
Please check one: New L'" Addition <br /> JOB SITE Dv5 a f1 \1 0 y)- 4 Yl <br /> Owner's Name 5o S a f) \\ m a Y) Telephone Number <br /> Mailing Address LI U \Pre a( corvz. N vi <br /> Sprinkler Contractor's Name A C V IA 1=n g, rt-v)7 Telephone Number S 7 —'i Ci I-//3 <br /> Contact Person 1T Ce VA o)a sc K' <br /> Mailing Address 1" 5-6 1 C )=1 q <br /> WATER SUPPLY <br /> Lake Well ✓ City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers V\04\ c) (' z cxZ 33 <br /> Uig 0 S 70 002_ 9 <br /> TOTAL Li Z <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: 2c'00 Sq. Ft. <br /> Coverage per Sprinkler: ;-7 0 Sq. Ft. <br /> No. of Sprinklers: L12, <br /> Total Water Required: p 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 5 ( �1 o) a Z c Date Z/2 7/Z 0c'2 <br /> ********************************************************************************* <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> Date <br />