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.- <br /> � <br /> Please check one: New Addition� Limited Energy Technology <br /> Systems License # <br /> JOB SITE I� �COl1�(� � �� <br /> � ��Owner's Name ^ (�h �S Telephone Number — � � �' �f <br /> Mailing Address �,� C (� " � � , <br /> SprinklerContractor'sName C� I �, `1� /��lephoneNumber q�—��9 "''�--��-2� <br /> Contact Person ��+(1 Yl <br /> MailingAddress �g�, � -1 h `" (i°� �� �� <br /> WATF.R SUPPLY �5��� <br /> Lake �'�'el] Cit�i� <br /> BACKFLOW DEVICE <br /> AVB PVB�� <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers �'6 (Y�(��t l��� � --d� � <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 FF,E CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 7. Ct�t" �UI'''f:'d''cr� ,p .Jr`V <br /> 3. Mail-tn 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 ofthe City and State regulations,and cer�ifies that <br /> all statements made on this application are complete, true and correct. <br /> �"1 <br /> Applicant ��� :�"� Date �p — ��� <br /> ��, <br /> ****************************�:**************************************************** <br /> Approved Approved with Corrections Denied <br /> Reviewed By: Date <br /> k Reset Form <br /> �f <br />