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. � <br /> Please check one: New i Addition Limited Energy Technology <br /> Systems License# <br /> JOB SITE j� y � � /'��,,��,� � �� <br /> Owner's Name_ i2� ������f�m Telephone Number <br /> Mailing Address <br /> ? � - �� -.�z.��s <br /> Sprinkler Contractor's Name�C y�L,--�.� ,c�.��,G�Telephone Number l i,� _ ��,�, �oZ���C, <br /> Contact Person ,-d-� '—/�,.Y,��, <br /> � <br /> Mailing Address �/,i� � �� :-, �.l'. (�� �� � �`�,-n,%, <br /> WATER SUPPLY <br /> Lake Well �ty <br /> BACKFLOW DEVICE <br /> AVB PVB //��� <br /> Year of <br /> ake Model Manufacture uantit <br /> Sprinklers �-,�, �,- ,-- �G i� � � � �: <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 /> � <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ -�S,5 L; <br /> The undersi�ed hereby applies to the City for issuance of a Sprinkler System Permit, a�-ees to do <br /> all work in strict accordance with the ordinances of the City and State regulations, and certifies that <br /> all statements made on this application are complete, true and correct. <br /> _._ <br /> Applicant _ --= �� r`� Date /G <br /> ******�* **** *************�*************************�************************* <br /> Approved Approved with Corrections D�� <br /> Reviewed By: G��� Date �U —b "�� <br /> � C��� �� ;�SPE �-,-; v... n� �� ; cC�-P�� c�;�.� <br />