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� � �� � <br /> . <br /> f - '� q <br /> Please check one: New Addition - <br /> JOB SIT'E <br /> Owner's �'ame� `���,�-��.� ,;�,''����,r� Telephone Number ����- �L(� <br /> Mailin�Address��y�, �rs'C� �a;r�� 5��� <br /> Sprinkler Contractor's Name �,�� -,r�n n�� �i t�,�, Telephone Number ,-�-�2,-;S`)�,�_ <br /> Contact Person <br /> -���,n ��I � <br /> Mailing Address ��,�{� �-1 er�.a�, ;�`�_S<��-�I-, <br /> WATER PLY <br /> Lake Well City <br /> BACKFLQW DE ICE <br /> AVB !� PVB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers - �h-)-e,r ����' ��.,� � �� <br /> -���2� ���Z �� � c � <br /> � �� ������ ���� �� <br /> /fv �c�-M,s I-h,,, � �' C <br /> TOTAL � `-3 <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: C�CCa Sq. Ft. <br /> Coverage per Sprinkler: � ���3�+�c, �j�r� ,?��-�- ��Z_ Sq. Ft. �. <br /> No. of Sprinklers: � 53 <br /> Total Water Required: Z� GPM <br /> �ERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e. $ .50 <br /> 3. �Vlail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ .3�1.� <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 regulations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> ; � �l <br /> Applicant � Date C, IZc�/�'� <br /> x��:��x��*x��������� **��x*����k�k������x��x��x�x��x�X�XX��X�����*����:������x�����x�*��*� <br /> Approved � Approved with Corrections Denied <br /> Reviewed b : � � <br /> F , ` �, ______ <br /> �„�_� /'�- ��- ��,��_ Date �'��� <br />