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J► - � _ _ <br /> Please check one: �New Addition � <br /> JOB SITE (,��� � & � � �� � L- �-- G � <br /> p � <br /> Owner' s Name � rn l�c.��l � �-�'' Telephone Number �� <br /> Mailing Address �`t�� �, D r'�Y'� f �a('.2--� <br /> Sprinkler Contractor' s Name �z-�-Q C, �✓ri ac�,on Telephone Number 1 � - 7$oZ <br /> Contact Person <br /> Mailing Address 3 ��D Li r/i �G 4�)n <br /> �*********�****:t*********t **��*�******:*******:****#*:******#*********�# <br /> CLASSIFICATION OF OCCIIPANCIES <br /> Commercial Residential � <br /> *�t**t�**:******:**********t****** :***t*#*#tt********t***t***�**t**�**:** <br /> WATER SIIPPLY <br /> Lake Well � City <br /> *************�************* ***�***�*****:*****:****�***********�******�*�* <br /> Year of Orifice <br /> Make Mode 1 Manufacture Size uantit <br /> Sprink ers IR • <br /> TOTAL � � <br /> ****#************t**********�******t********��*��*#******t***************** <br /> HYDRAIILIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: � '7 <br /> Total Water Required: GPM. <br /> ****�*********t*********t*****�*****�********�********************t******** <br /> P$RMIT FEE CALCIILATION <br /> 1. Permit Fee $ 30. 00 <br /> 2. State Surcharge. Based on valuation. $ .50 <br /> 3. Mail-In Fee $ �-0 <br /> 4. TOTAL PERMIT FEE add lines 1-3 above $ 30 .5 v <br /> The undersigned hereby applies to the City of issuance of a Sprinkler <br /> System Permit, agrees to do all work in strict accordance with the <br /> ordinances of the City and State regulations, and certifies that all <br /> statements made on this application are complete, true and correct. <br /> Applicant � `' � ����/ Date <br /> *************** ********** ****** *************************************** <br /> Approved Approved with Corrections Denied <br /> Review d by <br /> --��:��i�---" � � . <br /> Dat <br />