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v <br /> 6 <br /> Please check one: New Addition <br /> JOB SITE <br /> Owner's Name o g (.,QJA-Apo� Telephone Number -I) <br /> .-47 <br /> Mailing Address 4,4/,> / <br /> Sprinkler Contractor's Name A9 u £-.ri6 . Z,r Telephone Number ,y/—//3 6 <br /> Contact Person LA-SEIC <br /> • <br /> Mailing Address 10 #'7'j GT'IGt5 -c 7 cif, i+�W '/le <br /> — LO�u• , !e <br /> WATER SUPPLY <br /> Lake j Well City <br /> BACKFLOW DEVICE <br /> AVB PVB RPZ <br /> Year of <br /> take Model Manufacture Quantity <br /> Sprinklers <br /> 4a4,e <br /> rue- 10 ,19 /713 �9 <br /> TOTAL 1 <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: r-' Sq. Ft. <br /> No. of Sprinklers: ,9 <br /> Total Water Required: /7 GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $$ 35.00. 0 <br /> 2. State Surcharge. .50 <br /> 3. Mail-In Fee $$ 1 1. o� <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 <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> Applicant Ailt-‘0-4-0---/ Date 4G,23// f 2 <br /> *************** ************************************************************ <br /> 9 ** <br /> Approved Approved with Corrections Denied <br /> Reviewed by 0';� <br /> / F i � Date 6 <br />