Laserfiche WebLink
� �o0 9 -O d 33 0 <br /> � <br /> �-/7-09 <br /> , Please check one: New� Addition <br /> .rOB SrrE�.�.� C,9-5 Gv 1�0 ��,v I 1�a��o <br /> Owner's Name j� �/l�'C � f}�,(.(y�'�� Telephone Number <br /> Mailing Address �/r»� � <br /> Sprinkler Contractor's Name �q�,�, �„L,. �� TelephoneNumber ,y'"�--�f//^/� 3 �j <br /> Contact Person <br /> Mailing Address (,0,5�. G 1` (�t,J i � �W • <br /> WATER SUPPLY <br /> Lake�_ Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers 3 6-- �0 <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 /> l. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .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 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 /> Applicant � Date D <br /> ************ *****�************************************* ******************** <br /> , <br /> Approved � Ap roved with Corrections Denied <br /> Reviewed by: � <br /> - Date���, • � _� _ �;� c� <br />