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� } �.���u� � ��a9-�o�,��" <br /> � - � <br /> ��e�� �� eC�� ��9�� <br /> Please check one: New� Addition Limited Energy Technology <br /> Systems License#' I S�3� <br /> JOB SITE (0 � C h e.v� .��� � ;�.�ti ��z ��� ��� �"-�-��t 1 <br /> Owner'sName -�- L1�ciZj_�� '��`j�}�� TelephoneNumber �p1�-�- ���o��q <br /> Mailing Address 1�1 � �,;i�v � nA��L�j�Z; , �.�,��L���� '� � , <br /> Sprinkler Contractor's Name'`��-;�� �,,,��g p 5' ;�.y Telephone Number QS�--`j 33�-�c�'�%f <br /> Contact PersorF�� ,.�� � a � �L �-- � ��, �i Z—� �o� ���O�..�� <br /> Mailing Address J_�`_�1�o I`,�>>�r-lr�;,�����r�-��� ��S �r� � �-Yk'-� ��_��—�`�� <br /> WATER SUPPLY .\ , <br /> Lake Well City x <br /> BACKFLOW DEVICE <br /> AVB PVB _� <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers u�-rq � ��,� F� �c.� �,� 2 ? <br /> � : u e,� <br /> ����� <br /> � ��:.l ' f�Z . ` � �, j , U� Z <br /> T�TE�. L <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: 2��, `� � Sq. Ft. <br /> Coverage per Sprinkler:Z,�L�-3�����.,�,y�� -_� ��� �U� — �td� Sq. Ft. <br /> No. of Sprinklers: � c�. q <br /> Total Water Required: (p 6�y�.� GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ �,�� <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3�-�p <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 /> Applicant . � D�e �',— o--�c� <br /> ******* ************************************************************************ <br /> Approved��_ Approved with Corrections Denied <br /> Reviewed By: Date � � � ' d � <br />