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�� �w� � <br /> ��� °� � � � <br /> ' Please check one: New Addition � <br /> JOB SITE �Z f_�,r4.Sc� b I"O�rv i � <br /> Owner's Name��� ����� Telephone Number <br /> Mailing Address �-� fz..._ <br /> � <br /> Sprinkler Contractor's Name �, (,_ � Telephone Number /- /,� <br /> Contact Person �.k; <br /> MailingAddress (�S(p � ��r-L,��U'�� �14-�e.pCwH�( • <br /> WATER SUPPLY <br /> Lake � Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Ouantity_ <br /> Sprinklers <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 /> PERNIIT FEE CALCULATION <br /> 1. 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 <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 /> � Applicant Date ��v�` � <br /> � *�*****�***��x*��*�*****x�**����*��x****�*********��**��******��**�*�x*******x�**�� <br /> � Approved Approved with Corrections Denied <br /> , <br /> � Reviewed by: � <br /> Date �� <br />