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Please check flne: New Addition - � � , <br /> JOB SITS <br /> . <br /> Owner' s Name Telephone Number <br /> Mailing Address <br /> Sprinkler Contractor' s Name Telephone Number <br /> Contact Person <br /> Mailing Address <br /> :*:**::#**+r::�*#::�:�c*:::::r�:*��*:*::*:*:�*�**:t::�t:#::**:**+c:s:t::::#�ss: <br /> C�ASSIFICATION OF OCCIIPANCIBS <br /> Commercial Residential <br /> ��t*f,r:*:**t***::*s***t�rtt**�t**:�**:*::*:*:f***#f#f*#:*�*:�tt***t:�r**3:t**�tt <br /> WATER SIIPPLY <br /> Lake Well City <br /> �,��***:**:**��*t***t�::*:t*:::*�*:*�*f*�**:�#::::x*****#,r:*:::#�r:*:::*sr*�*#* <br /> Year of Orifice <br /> Make Model Manufacture Size uantit <br /> Drinx ers <br /> TOTAL <br /> *t:***�*�*t*:*******s*t:*:*:**tf�*t**:t*,rs**#*:::,t�**��t�ttt*ft**:**#*t**�*# <br /> HYDRAQLZC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> �o�erage per SDrink�er: Sq. Ft. <br /> No. of Sprinklers: <br /> Total 'Aater Required: �pM• <br /> ***�t#****�:*#*t**tt,r***�*****:f**********:**:****t***�*#****�r:*#t,rt*,t**�**: <br /> P$RKIT FSE CALCULATION <br /> 1. ?erm�t Fee S 30 . 00 <br /> 2. State SurcharQe. Based on valuation. S • �� <br /> 3 . Mail-In Fee $ 1 . 50 <br /> 4 . TOTAL PERMI� F� add lir_es 1-3 above $ <br /> The undersigned hereby applies to the City of issuance of a Spr.inkler <br /> System Permit, agrees to do all work in strict accordance with the <br /> ordinances of the City and State regulations, and certifies tr.at all <br /> statements made on this applicat.ion are complete, true and correct. <br /> Agplicant Date <br /> ********,�,�***************#*********************�***�*,�*********���*��****�* <br /> Approved Approved with Corre�tions Denied <br /> Reviewed by: <br /> Date <br />