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_ <br /> � Way-1T=2�02 OT:28am From-CITY OF ORONO +g522494616 T-258 P.003/003 F-812 <br /> Please ch�ck one: New � Additian <br /> JOS 57TE �r`J`•� C� ' � <br /> , �v�mei's Name 11� �Y�1�C� ��l(1 C� T�leph�ne Numb�er��,� 'y �,� - ��/5 <br /> M�lin�Address i�i�'I � S /� /E <br /> . Sprinkler Contr or'sName E ('��fG�' CAS't�`t`��, �e]ephoneNum�r��' �7�1��%�/ <br /> � ContaCi Person V,� N,�, /� <br /> �Aa�� Si �. �- lN��u,Si�zi� -�� - �, l l/�i�✓ /�'l�/ 53��`� <br /> �� <br /> � V�ATER ST7PPLY <br /> Lake Weii � City'� <br /> �ACKFL�W DE`V'i�7: <br /> AVB �� PVB <br /> • ' Year of <br /> Make Model Manufac�te�re uant' <br /> Sprinklers tAN� (2 (".� _r _ �'C�C�' 3 ,�' <br /> TOTAL - C' <br /> �'Y�RAIII.IC CALC�LATx�NS Design Data: � <br /> Axea of Application: /s�� Sq. Ft. <br /> Coverage per Sprinkler: �� Sq. Ft. <br /> No. of Sprinklers: "� <br /> Total Water Required: _ I GrPM <br /> . •—r- <br /> PERNIIT FEE CAX.��T.A'TYOl� � � . <br /> 1. Permit Fee $ 35.�0 <br /> 2. Sta�e_Surcharge $ ,50 <br /> 3. Mail-Yn Fee � $ -�--�- <br /> 4. 'rOTAT.PERMTT FEE (Add lines 1-� �ove) � � .3� ��c � <br /> The undersigned hereby applies ta the City far issuance af a Sprinkler System Permit, agrees to do <br /> aI1 work i�s stzict accordance with the ordinances of the City and State regutatioAs, and certifies that <br /> all statements r�qde on this application are complete,true and cotrect. <br /> � � �IZ 3�� 3���� �i <br /> �pli�L c� � �- ��-v.� . <br /> �********************* ****�************�****�*********�*�***************��*****� <br /> APproved P,n i� Appr ved with�orrectioas Denied . <br /> Reviewed by: �,,��'` � 'yti'--� Date � _ ��'� � <br /> � �' �r J ,�_t�c•l� �E��R CC--}.u,� wl-,i=. l d,�(�I t}�Cv � . <br />