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_-- . � rgg� <br /> Please check one: ��ew Addition - � <br /> JOB S�� ��f 7� � �. l+��l�� S�� �.���t��5�� , � �/ ��'�✓ <br /> Owner' s Name �1'i ��/ � � � ��� Telephone Number `t�7C`� ��� <br /> Mailing Address U� ���� �� -�� <br /> A� � � ��� Tele hone Number� ��'� L �� <br /> Sprinkler Contractor' s Name p <br /> Contact Person ��� ��� ��� <br /> Mailing Address <br /> :*�******t***********�****��*********************�*******t***************#* <br /> CLASSIFICATION OF_ O�CQPANCI$S <br /> Commercial Residential <br /> ****�***t**t******�*t***t:*******t**t***t�t*�r********tt*******t:**�**#t**** <br /> WATER SIIPPLY � <br /> Lake Well City <br /> *****�********�:*t**#****************�***:�***#:*****�**t***�***�*��**�***� <br /> Year of Orifice <br /> Make Model Manufacture Siz u ntit j (� � <br /> S rinkle s C . � � �j�� �J <br /> . , � ...._-, <br /> �- � � ���� <br /> TOT�r. �-1 J�'� <br /> **�*�**#***************************************t**#*****�*********��**�**** <br /> HYDRAIILIC CALCIILATIONS Design Data: 7' � �,� �F�tT ���6 <br /> Area of Application: Sq. Ft. $���� �� <br /> Coverage per Sprinkler: Sq. Ft. O N.�� � 0��� <br /> No. of Sprinklers : <br /> Total Water Required: GPM. ��� ��S��' <br /> ***********�****#*****�**************�*****�***********t************#****** <br /> PERMIT F$E CALCIILATION <br /> l. Permit Fee $ 30 .00 <br /> 2. State Surcharge. Based on valuation. $ .50 <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 of issuance of a Sprinkler <br /> System Permit, agrees to do all work in strict accordance with the <br /> ordinances of the City and State regulations, and certifies that all <br /> statements made on this application are complete, true and correct. <br /> � � � �r � �� l <br /> Arrlicant �, � �� Date <br /> **�*********** ******************************************************�***** <br /> Approved Approved with Corrections Denied <br /> Reviewed b : <br /> � - �'�S�� . <br /> Date <br /> � <br /> i <br />