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Nay-1T-2002 07:28am From—CITY OF ORONO +9522494616 T-258 P.003/003 F-812 <br /> Please ch�ck one: New � Additian <br /> � <br /> ao�srr� 3�3�� �i��� -1,�� - .,.. _ <br /> , 4�vne.�'s Natne �,..ti � JC- TelephoneNumbrr `7/ ��(p <br /> M�ilin$,Addre.ss S�17"ti' C�� �� ,_ ,., <br /> ^ . Sprinkler Can o�s Name;�C( '- - �'C �� / n.'C Teleplwnel�umher ,l1,���/'7 j',�1�-/ <br /> Contact Person � /��'E N'� !�m - <br /> �,�aar� �l l,5 �ru����raG ���. - /'12��r ��ti. /I7�✓ ���5� <br /> T <br /> � ATE LY <br /> Lake WeIl City_ <br /> �ACKFIAW 1�'�'V"t�: ���� ��� , <br /> AVB � PVB <br /> ' ' . Yeax of <br /> 1V1ake .M�.del Mant�facture uant' <br /> Sprinklers !-� � 'r -:�C^ , f;C'3 <br /> v.N �tr��. 1 �� � ,� . . ��5 �3 <br /> 1�TAL c��" <br /> �Y7aRAIILIC CALCIILATXQl�TS 17esign Data: � <br /> Area of Application: o`� �f'''�� Sq. Ft. <br /> Coverage per Sprinkler: ��'- f��'. `�o-�f;;> i�' �� Sq. Ft. <br /> No. of Sprinklers: :� �S <br /> _ <br /> Total W ater Required: _ �� GrPM <br /> PERMIT FEE CA�.�Y.�.�A1'TON � � <br /> 1. Permit Fee $ 35.a0 <br /> 2. Stat� Surcharge $ .50 <br /> 3. IV�ail-Yn Fee . � $ 1.50 <br /> 4. 'Y'OTAL PERMTT FEE (Atid lines 1-3 abo�ve) � $ � <br /> The undersigne.d hereby applies ta the City far issuance a�a Sprialcler System Permit, agrees to da <br /> all work in strict accordance with the ordinances of the City and State reguiations, and certifies that <br /> all statecnents i�ade on this application are complete,true and correct. <br /> . �,I <br /> �' _ ' . <br /> r' <br /> APPlicanL , ��i�n� �/� Aate F�' �`� G,3 <br /> �****************** ************�***********�***********��*�r****************�**� <br /> APproved %��h� A.pproved with Corrections Denied , <br /> lteviewed by: � � <br /> �� '�-�r�tie.�� �� -�-- I� �3 <br />