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� � <br /> Please check one: New � Addition � . <br /> JOB SITE S � ✓L l U�1 G�7 G - <br /> Owner's Name S-� e,,�,e a �� o �� Telephone Number --lC//� <br /> Mailing Address �v2�js o . � �.. . J'U�O <br /> � Sprinkler Contractor's Name � c,m e S-er c,`�.e o� Telephone Number ��'-��j�� <br /> Contact Person U^� Gt <br /> Mailing Address SC7O/ �c'i� ��'l� c.����.� � <br /> WATER SUPPLY <br /> Lake Well � City <br /> BACKFLOW DEVICE � <br /> AVB PVB � . <br /> Year of � <br /> e Mode anu acture ua t' <br /> 'nkle n �e � ��.4/- <br /> � � �X� S c, C�.ti�J/i <br /> . � To�rai, ' 7� <br /> �IYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: _ ���� Sq. Ft. <br /> Coverage per Sprinkler: / C3Z� Sq. Ft. -, <br /> No. of Sprinklers: �f <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 PERNIIT FEE (Add lines 1-3 above) � � $ . <br /> The undersigned hereby applies to the Ciry 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 o 's applicati aze complete, true and correct. <br /> Applicant Dat � <br /> e <br /> �����x����x�x���x�x�x�����x��x�x �a���x��x��x�����x���a���x���xxa��x��a����xa������x��x�x���x������x��� <br /> Approved .� Approved with Corrections Denied <br /> Reviewed b . <br /> Date � <br />