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.T �`�`�-`- <br /> , <br /> Please check one: New Addition <br /> JOB SIT`E J�- � �, <br /> .� r <br /> Owner's Name ��� �� �i�/�,� ��„ c; ��— Telephone Number <br /> Mailing Address � ��"ra'� � ��` �' � �C L� ,� � <br /> -�- �4 � Y��fi� <br /> Sprinkler Contractor's Name �-L` A, Telephone Number � C �;_ 7� <br /> Contact Person L< j� =— � �?�1t -� �. <br /> —� <br /> MailingAddress � � �'� ` <br /> � ���2l �- /1.����' /�� �� � ����. <br /> WATER SUPPLY <br /> Lake Well � City <br /> BACKFLOW DEVICE <br /> AVB PVB ��'�� <br /> Year of <br /> � Malce Model Manufacture Ouantity <br /> Sprinklers � �/�����_��E'� � � <br /> � • � <br /> _ � <br /> . � L <br /> TOTAL b��� cee'� <br /> / <br /> HYDRAULIC CALCULATION 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 Surcharge. $ .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 for issuance of a Sprinkler System Permit, agrees to <br /> do all work in strict accordance with the ordinances of the City and State rewlations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> < <br /> Applicant j���� �f'��2, �" Date � <br /> ����Xx�����x����x�������������x����k�x�M��x�k*�x�x���xxa��kx�x���k���XM�������x��a���a�*�x��� <br /> Approved Approved with Corrections Denied <br /> Reviewe ' <br /> !./v�'�`" ' � <br /> Date /�--� � <br />