Laserfiche WebLink
/ <br /> • , ��C)�� <br /> �35 � <br /> o��z- <br /> Please check one: New Addition Limited Energy Technology ��� ��" <br /> Systems License # �qL� <br /> JOB SITE � � � �'!�-� hi- �� , dP.,� <br /> Owner'sName �j,�2,1 S d-�r����� ��D1.-�.�r�/TelephoneNum er l�L-`f? C�� S'`jg `� <br /> Mailing Address a-� t-} � �,�s c� f�- �� C:+PvY�L, , �'l�r.� <br /> Sprinkler Contractor's Name Telephone Number <br /> Contact Person <br /> Mailing Address - <br /> WATER SUPPLY <br /> Lake Well City_� <br /> BACKFLOW DEVICE " w ` �� N Q Q � 3 � � � � �O� �� � C� <br /> AVB PVB ='� � � 'T �%it1 /� ( �Tit S I��" �-�-} - <br /> Year of <br /> � Make Model Manufacture uantit <br /> Sprinkler� Iv2.-v L)�v� t�.�.,-� �-� ={�1 � 1��� 1��'�r �2..�� �l2�'ti.-. <br /> ( u2� .� ��rn�-2 r`�li�wC--��� ��nLl Ga;�e�yE rn�'« Ca��cM�--:S <br /> �--i S i �s i��,-��fl. <br /> - � �--i 0(2-0 �.�.,P.�� l.�-1 i�� ��S J`f�-u �1 y F��. <br /> TOTAL <br /> HYDR.AULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: �-}5 <br /> Total Water Required: 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 application are complete, true and correct. <br /> ---_... <br /> �_�" ��,, � , <br /> � / 5r�r�� �_ � _d� <br /> Applicant j � G --�-� � Date <br /> ******�****�******�*********�*******�*********x�*�*************�****************** <br /> 52e <br /> Approved �� S d�,�Approved with Corrections �v�:e Denied <br /> A /30,�� <br /> ReviewedBy: ��� �'����'�: Date �" I��� d � <br />