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. . p� a�� <br /> Please check one: New � Addition <br /> JOB SITE � � !� � o � �R. a � �h i�c� CG �, a vt o ( `� 1L° <br /> Owner's Name C'��( �C� �s- Telephone Number <br /> Mailing Address � � ''"� r <br /> Sprinkler Contractor's Name � +P Fe � �-(.�e�F:z '� . c Telephone Number .S yG 6 1.3� <br /> Contact Person C � c� � � �j i .-� 6 h �' <br /> Mailing Address /�.�ez �' /Y (/C� /5' � �-r�� M T��'� 7"� y -, t 5-3� �' T <br /> WATER SUPPLY � <br /> Lake Well )( City <br /> BACKFLOW DEVICE <br /> AVB PVB � RPZ <br /> Year of <br /> Make Model Manufacture uantit <br /> �rinklers L'�7"c�f' �� �' '� ° L ` •- <br /> ��.� b, R� I��n d v �,� <br /> 7�� <br /> HYDRAULIC CALCLILATIONS Design Data: , <br /> Area of Application: !�S .Q� � u , � �� Sq. Ft. <br /> Coverage per Sprinkler: �` " Sq. Ft. <br /> No. of Sprinklers: " <br /> Total Water Required: �D 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) $ 3 5, SZ� <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> Applicant � � e � � k � �'�� "' � � c Date �— ��— 4 � <br /> **********************************x�*******�x��*************�x�***************x�** <br /> Approved /� Approved with Corrections Denied <br /> Reviewed by: � <br /> �'� Date 7''1��1� <br />