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� � ��6 �� <br /> � /D-3/-D 7 <br /> I I-Z�� <br /> . �3� � <br /> Please check one: New �/' Addition Limited Energy Technology <br /> Systems License# <br /> JOBSITE _ Z'��f� �r���[} ���,,, � � <br /> Owner's Name �d w��J �.,r{��-� Telephone Number <br /> Mailing Address Z��Iv �.k��� ��+��- � <br /> Sprinkler Contractor's Name�u�f auM,��, <<l Telephone Number�'� Z��''�� <br /> Contact Person_ 1���,� �.c,�w�ry ��,�y'; � \�c,�; �,��r,� <br /> MailingAddress - Ilo�c� �c, A 1�_ l�� S �� '1.�� ��..c.�g 5'�"�t� <br /> WATER SUPPLY <br /> Lake_��Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers �11�-..� �� i � S`�� ��,'1 �� <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 /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharae $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTALPERMIT FEE (Add lines 1-3 above) $ <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees 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 /> A licant �� � �' � - �` <br /> rr D�t� � �i <br /> ***************** ************************************************************* <br /> Approved Approved with Corrections Denied <br /> � <br /> Reviewed By: �,..,5 Date � � � 1 ��`�� <br />