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� - �� ` <br /> �� � �- <br /> � <br /> Please check one: New ✓ Addition <br /> JOB srrE / a.3 ����✓►� ��.���s� r�� ✓t o���,.�� <br /> � Owner's Name ,s ��(,/�/�� �Il ��5, Telephone Number <br /> Mailing Address s�/�/r <br /> Sprinkler Contractor's Name ��Q���f(�C�'�� �n/�., Telephone Number`j (�-O �� <br /> Contact Person G�-�"/�r`/j�' .�/ MG�'� <br /> ., a S-' <br /> Mailing Address �cr,3a� /yi/I//UG ��Gff���► ��..✓D. M/ N/'YL 1ana,r�'f�, I%'/✓� S.S .3 <br /> WATER SUPPLY � <br /> Lake Well City ✓ <br /> BACKFLOW DEVICE <br /> AVB PVB � RPZ <br /> Year of <br /> Make Model Manufacture Quantitv <br /> Sprinklers /�c�N fi�l�'' �'l.� P r�r:�� — <br /> -' 4,a,iv6��G ��oa a'vva — <br /> TorraL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: s /�C �U/�"j�:,C� Sq. Ft. <br /> Coverage per Sprinkler: i' i� Sq. Ft. <br /> No. of Sprinklers: �° " <br /> Total Water Required: / ,� GPM <br /> PERMIT FEE CALCULATION <br /> l. Permit Fee $ 35.00 <br /> 2. State Surchar�e. $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT F�E (Add lines 1-3 above) $ <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> Applicant C�/�'�t 6'.i i��°_-k /���� —L.-��r'�� Date <br /> ******�***********************�***�*********...**���******�*****x�*********�***** <br /> Approved Approved with Correction� Denied <br /> Reviewed by: � <br /> !�� �`'ef�tiZt,O Date <br /> � l�dcl���a�,� � ��� f ��e��ir��-�o i-�r . �"lw ,�A�K �IDW ���' ✓P✓�� -� <br />