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��,�C��c��� ��-� <br /> ` n . . <br /> Please check one: New �Addition u __ �0F ^-: <br /> s; , �� (v �> <br /> JOB SIT$ � �� �����V ����,�(� I�'�• - <br /> Owner' s Name ��tYl �r��/°�'l�wel� Telephone Number " �T-'`I"�� <br /> Mailing Address ��� ��1�l/�l �`I�f� N�� N/AY <br /> Sprinkler Contractor' s Name �(G�(,�fl'ftr�G(tiiJ�'r/�JK�I�Telephone Number ��,��'���� <br /> /� .L � � � . <br /> Contact Pers.on /✓��'�l �1/,�11 �il�'��„ <br /> Mailing Address ���� �� ���r��/ ���� ������ •�G; -��l � <br /> ******�**#*****t******�**�** ******�***��**#* �**********�****************� <br /> CLASSIFICATION OF OCCIIPANCIES <br /> Commercial Residential �� <br /> ********�*******************:**#******#**�**##*�*#*�:*�****�******�****t�** <br /> WATER SIIPPLY � <br /> Z3ke Wel? City <br /> �*******�************��*******************t�***************��**�*#*:******* <br /> Year of Orifice <br /> Make Model Manufacture Size uantit <br /> prin lers �r,�Y � - .� Q 7' <br /> TOTAL <br /> ***********�**�*�*�*�****�*:************:*��****�******�*#***************** <br /> HYDRAIILIC CALCIILATIONS Design Da�a: <br /> Area of Application: Z ��v'G� Sq, Ft. <br /> Coverage per Sprinkler: c%' � Sq. Ft. <br /> No. of Sprinklers: 3 <br /> Total Water Required: �,5� GPM. <br /> *****�***********#***t***�*********�*******�******************�**�********* <br /> PERMIT FEE CALCIILATION <br /> 1 . Permit Fee $ 30.00 <br /> 2. State Surcharge. Based on valuation. $ .50 <br /> 3. Mail-In Fee $ 1. 50 <br /> 4. TOTAL PERIKIT FEE add lines 1-3 above $ <br /> The undersigned hereby applies to the Citv 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 /> r c� <br /> Applicant ����� ��� Date � '� �` C l� <br /> *************************************************************************** <br /> Approved ��:� Approved with Corrections Denied <br /> Reviewed by• <br /> . }. <br /> � �� • .'¢ � r x`; <br /> , _,� � " <br /> Date <br />