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r,Nt B-Zq-� � �a�"a7 <br /> . ,4i� 3�S <br /> � -. ,< �3S � <br /> Please check one: New /� Addition Limited Energy Technology <br /> Systems License# <br /> JOB SITE SU �v ��.-sc cs � <br /> _� y �l � c'�/ <br /> Owner's Name�%'� � ��< <�,����,,� T ephone Number `�.1� �/�/�-�'a� <br /> Mailing Address —'� � /J �_ ��- ,_; y j;ie-!�/��/ ,—, <br /> ,�� - �, �',�',..� <br /> �---- , <br /> Sprinkler Contractor's Name �G'C".� �f -� �..,:���,�..Telephone Number <br /> !-- �,_— <br /> Contact Person / ./���� �.�--,,��, j� �; �, <br /> Mailing Address . ����� _ <br /> WATER SUPPLY <br /> Lake Well City� <br /> BACKFLOW DEVICE <br /> AVB PVB � <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers_ �.c';� 5 3�-1 S � J..� � js <br /> 7o r�' ;a S 3�-S� � � /� <br /> � 3 3`��- ., �/ <br /> J� � <br /> ��' _._'°�"' / T�Z'E�.. ,� <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: //, v�:u � — Sq. Ft. <br /> Coverage per Sprinkler: it/t, r'_,/G1�, Sq. Ft. <br /> No. of Sprinklers: 3� <br /> Total Water Required: S � c.�4�:2.,�,;�� ,t=',�- � // GPM <br /> PERMIT 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 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 applicat' mplet e and c ect. <br /> '—'�� . " <br /> _ , ,_ <br /> ,,�' ' ' <br /> Applicant . — � —�'" Date �J� � � 'J� <br /> *****�*********** **� **************************************************�******** <br />