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t-/ /kW" &.1c2 <br /> Please check one: New $. Addition <br /> JOB SITE F3r cc�j/U�� /urc� S- 3 L <br /> Owner's Name /' * MA6 S' 7 A g5911-2/a. TelephoneNumber (901 .7 <br /> Mailing Address -) JJ/ if 3 A ' & k ET <br /> Sprinkler Contractor's Name /PAjA-- C 4 Telephone Number l4' - (7 7 <br /> Contact Person tpE (9'10/015- <br /> Mailing <br /> Address 3 7 PG' 7177 67/ /1/ - Lv A co Ai/ • <br /> 3 7 <br /> WATER SUPPLY <br /> Lake X Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers j�/L/Ai /-� A dT o/ /4- /7E-R f1 A ,v s <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: GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge $ .50 <br /> 3. Mail-In Fee $ <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ LJ <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees •-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 (00/ <br /> Approved /v (3 Approved with Corrections Denied <br /> Reviewed by: (,�, atykvaly <br /> °', cutc <br /> Date 6-a3.-o <br />