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�. <br /> , <br /> Please check one: New� Addition Limited Energy Technology <br /> Systems License # <br /> JOB SITE <br /> Owner's Name `���� (�-1�ZS�='� Telephone Number ��z l z--� S�, 7(�-��i <br /> Z�� � ' ( <br /> Mailing Address � �4--�G�j �� ���1 <br /> SprinklerContractor'sName �z�� �J� � TelephoneNumber <br /> Contact Person ���U� �`_���/� <br /> Mailing Address - <br /> WATER SUPPL <br /> Lake Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers <br /> � � � ��� <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: (p <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) $ 3 5" <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 ma �ation a e complete, true and correct. <br /> Applicant � Date �� `� -v � <br /> ******�************�x******��***************�x**************************��x********* <br /> Approved Approved with Corrections Denied <br /> Reviewed By: Date <br />