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C N <br /> Please check one: NewAddition <br /> JOB SITE C,., t , s r <br /> Owner's Name 6-n s w r sT Telephone Number <br /> Mailing AddreAc /V LA) r__._./._÷..J2Ze___ <br /> Sprinkler Contractor's Name 0. E. T Telephone Number 19 S.. - /0 0 0 <br /> Contact Person 0 ,., ( c_ +c uz.sa <br /> Mailing Address <br /> WATER SUPPLY <br /> Lake —Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers R +o ,,,i ?G kli 14 L, i.,i c ,/ z <br /> PGP rE 4 c✓J 3 7 <br /> TOTAL 5-7 <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: 5 7 <br /> Total Water Required: 2 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 ordinances of the City and State regulations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> Applicant f.---..-10/ Date ` /— ' <br /> Approved Approved with Corrections Denied <br /> Reviewed by: � <br /> ��/�� Date Y-2/1 / <br />