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. � � �C,�?.�=� <br /> Please check one: New Addition <br /> JOB SITE �2 � � � n� � ' <br /> Owner's Name� .��- � Telephone Number ? <br /> Mailing Address 3 Z /� �c�..,�,,�,�-C 6�r,Q, ' /�'�-�, � ' ``—� <br /> Sprinkler Contractor's Name�hhr-ENz�,,t,e�� V Yl G�r�� Telephone Number 7p O <br /> Contact Person � <br /> MailingAddress � � �- � � f�' �S �U � <br /> WATER SUPPLY <br /> Lake Well � City <br /> BACKFLOW DEVICE <br /> AVB PVB � <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers " � vr✓T3-"'C f-�v 1���- �^� <br /> TOTAL <br /> HYDRALTLIC 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 Surchar� L��^�'`, $ �=,54� <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 eertifies <br /> that all statements made on this application are complete, true and correct. <br /> ' Date �� � � <br /> Applicant <br /> ******�*�*****x�*********�*�x*�****�x**���**x��******�*x�*�***�********�*��x�******* <br /> � <br /> Approved J� Approved with Corrections Denied <br /> Reviewed by: -. � <br /> Date `` ��"� <br />