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Please check one: New X Addition � <br /> JOB SITE Z�t oS ��,�,.a p.•,- <br /> Owner's Name_�.+.{�.o _.�., �v,pP Telephone Number y�Z y-�� -��g3 <br /> Mailin�Address Zyor� e;x,.�<<_�-j— ►��� <br /> Sprinkler Contractor's Name _ � � ,,,,����, TelephoneNumber -703 c.�y I zi�i l <br /> Contact Person GHrZ.�s S-�ak-�� <br /> Mailing Address I f �R�l Zl 9 ,o,�� ,.,�1 r rz, - r-i,�� ' <br /> `VATER SUPPLY <br /> Lake �Vell City� <br /> B�.C�'LO�V DEviCE - <br /> . AVB P VB �_ <br /> � Year of <br /> Make Model Manufacture uanti <br /> Sprinklers i o�Zv -7ob i � Z5 <br /> l o� � �']o �oo I [� <br /> TOTAL 3� <br /> HYDRAULIC CALCITLATIONS Design Data: <br /> Area of Application: �a-,o Sq. Ft. <br /> Covera�e per Sprinkler: �od• Sq. Ft. <br /> No. of Sprinklers: 3� <br /> Total Water Required: �o Gpy� <br /> PERII�IIT FEE CALCULATION <br /> 1. Pernut Fee $ 35.00 <br /> 2. State Surcharae $ � .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERiti1TT FEE (Add lines 1-3 above) $ �� �a <br /> The undersi�ned hereby applies to the City for issuance of a Sprinkler System Permit, a�rees to do <br /> all work in strict accordance�vith 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 ��.�.-rT-� �d,� � Date_�>> fo � <br /> ************�****�**********�********************�*****************�************* <br /> Approved X Approved with Corrections Denied <br /> Revie�ved by: �� <br /> Date 7-�6-01 <br /> �c (.on�e�-��,d � �l-o wqter rr�S-r 6� mqc�e 3y q ( ce�Sc� Plu�.6er � seperq� <br /> ���:'r ,r•��53- �t �53ue� �-pr �'1:.5 wD�� <br />