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is 2,1> <br /> Please check one: New X Addition <br /> JOB SITE ' , i , i <br /> Owner's Name DP.. ,'`164 u ; -• <' Telephone Number - 5'`/ 7'1 <br /> Mailing Address i4' r� ��� �! ( C>k. � . <br /> Sprinkler Contractor's Name r, .L, ,: ' Telephone Number qS <br /> Contact Person !-cc \ <br /> Mailing Address II 7 5 ' 1.1 <br /> r <br /> WATER SUPPLY <br /> Lake Well —1\ City <br /> BACKFLOW DEVICE <br /> AVB PVB '' -- <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers go'1.c) <br /> 7 l <br /> TOTAL • /'19 <br /> IYDRAULIC CALCULATION Design Data: <br /> Area of Application: - /t. Sq. Ft. <br /> Coverage per Sprinkler: (.47 Sq. Ft. N. <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 $ 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 Date 9 .;I9 ._91 <br /> ***************************************** �cic�cxiic***************>k* A**.**�c***** <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> Date 6, /3 /S <br />