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1412 <br /> Please check one: New (/ Addition Limited Energy Technology, <br /> Systems License # C&,o'e t5 <br /> JOB SITE ( 770 ./JOFU-4- (1n � . - <br /> Owner's Name ,S%/e r r y ,PA Iter o }J Telephone Number 9‘5":( Y'7 g °7 b 3 <br /> Mailing Address /7 7 0 (Ale./T C'/i r c^'` /'`J , Q ro rJ a s,5-3 6-6' <br /> Sprinkler Contractor's Name /ir t�,c.A,, 0.Zz._- Telephone Number 9 3-02- 'L-5- C 6`11- Y <br /> Contact Person d re,c2_, n <br /> Mailing Address /4Z `c_. 'or/;i/th r /oJ c4 a^/) Al Ve. , JN4(op,e_r-- ti J <br /> WATER SUPPLY / S 3-3 7 9 <br /> Lake Well V City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers /.",--/ iii o L- A4.5'voc) a,0 o (./- ex \ <br /> , /`/.. /400 ,2o0 r A / <br /> /i/,e_L VA) ,PA o - 6000 a,:O 0 171 7 D <br /> TOTAL 1%3 <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 8` 5 " 0 4/ <br /> **************************** *************************************************** <br /> Approved /•-'b Approved with Corrections Denied <br /> Reviewed By: ctac 1\11A----, Date CS-C-0'-\ <br /> Vop at-C sepr;(- _ <br />