Laserfiche WebLink
' � �} oy� �3 <br /> Please check one: New Addition � .3J`� cJ C� <br /> JOB SITE �-- ' s ��1,� �/ �1�,/G'� <br /> '? .> <br /> Owner's Name ���S��i`� ����.�'cl✓ TelephoneNumber <br /> � ,d� Mailing Address <br /> � � . <br /> $ 3 S rinkler Contractor's Name /,��� ��✓� i�/� ' <br /> " P Telephone Number �� � �-,S�f--!�� <br /> Contact Person `,/�-�---� r�� 0 �.� <br /> Mailing Address � �'/ � C�/ ���,-?�'c��/�y' • ,.�m-�.�,�,�'� �'--�� • <br /> `VATER SUPPLY V�J��z <br /> Lake Well City .-�' <br /> BACKFLOW DEVICE <br /> AVB �= PVB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers v� �'`�- ,� `,.'� /� ;.�<_%��/ �'Z_ <br /> � �,} ;E�� �y� �%• �' ,1��.�' ����� ,('' C� <br /> TOTAL 3� <br /> HYDRAULIC CALCULATIONS Design Data: <br /> G- <br /> Area of Application: ' Sq. Ft. <br /> Coverage per Sprinkler: �� Sq. Ft. <br /> No. of Sprinklers: 3 =Z <br /> Total Water Required: i � Gp� <br /> PERi1�IIT FEE CALCULATION <br /> l. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) $ <br /> The undersi?ned 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 /> f -' <br /> i� /�`�/ �7 j <br /> APPIic�_.-_- ;,'� �. ✓ -; ��� Date <br /> i" <br /> * ******��*********************************************************************** <br /> �_._—_ <br /> Approved �� Approved with Corrections Denied <br /> Reviewed by: � � f, � ' _ <br /> t`' i � , - ��� � ,� <br /> Date - <br /> � ' � ", i- � � �, � � � � , � , , � �; r� z. � <br />