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.53 s <br /> I <br /> Please check one: New X Addition <br /> JOB SHE / ' ' �I2//�J JGr .��f T - /f,'Owner's Name O09,, Telephone Number <br /> Mailing Address f�O /d/ /1"'��‘514-f 7''T, <br /> Sprinkler Contractor's Name f, ,e, «A-` Telephone Number 7 J— `-r2 r,g27// <br /> Contact Person - -e (-4->,,,,,,./c4 <br /> Mailing Address G, /c' / o -e �6_. <br /> WATER SUPPLY /—/ ' <br /> Lake X Well City / <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> MakeModel Manufacture Quantity <br /> Sprinklers (.c7 c7r /,c1 ( / Aeg 3 <br /> /1' 1 ,0a, <br /> 77 I1 <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: /�� `� `r 0 Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: 5 5, <br /> Total Water Required: /6:4. GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge $ .50 <br /> 3. Mail-In Fee $ .5 7-' <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ' s'c <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees too <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 ° Z-- <br /> *********************************************************** . ******************** <br /> Approved AL Approved with Corrections Denied <br /> Reviewed by: ✓ \ firj- ...,_,„ ,( <br /> Date u-' H— <br /> )r ('. I X- 5p t _.,., -.,l(r\ a0�� <br />