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'Please check one: New Addition Limited Energy Technology <br /> Systems License # <br /> JOB SITE 1 Z 5— 1,1;//t" V Yr <br /> Owner's Name L e LL ,` 5. Telephone Number <br /> Mailing Address /1-S- 1 (0,--3 <br /> �t-rte r <br /> Sprinkler Contr ctor's Name .Y Dro,1 w��.1/ .l 1. d Clephe$e Number "6 ?"2_-2-2-FA <br /> Contact Person OckY i A- \al%ll c x <br /> Mailing Address 1163O. a <br /> WATER SUPPLY <br /> Lake Well City - <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers I al K l's t t4 Sdzx.3 .et-z, y G�9 <br /> k.<<S u tit f 1(00D 'zoo v z <br /> TOTAL <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: 4' 1 /`Z 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 S .. L/*—v <br /> ********************************************************************************* <br /> Approved Approved with Corrections Denied <br /> Reviewed By: Date <br /> _ <br />