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. S <br /> l��� ��� ( � <br /> Please check one: New Addition <br /> � <br /> Jos srrE 1�-1 l �.�,t, ��� C 1�.s�� � r 1.����.�� � ---�.._� <br /> Owner's Name _ �U���e t' e7e.w�c.-�� �� TelephoneNumber ���.-- tl�?�� 1/�/�/ <br /> Mailing Address _ s�w� <br /> Spr�inkler Contract r's Name�.,,r;r� Y � � �,�.��i�u elephone Number %s z— `�Z�— l 3� <br /> Contact Person L�JG..,r�� , ;l ro� <br /> Mailin�Address ����Z ��i Ys�,,•�„� � 1� ,t�L �,,,,� i�-(n/ � <br /> `yATER SUPPLY � <br /> Lake `Vell City <br /> BACKF'LO`V DEVICE - <br /> . AVB P VB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers �..�vL`3',c � 6Cr��( Zoo 1 � f� <br /> ��7 w�:t�. 1$ (`� �va � `z._ <br /> TOTAL � <br /> HYDRAULIC CALCITLATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: :�`r� <br /> Total Water Required: U GPM <br /> PERII�IIT FEE CALCULATION <br /> 1. Permit Fee $ 3 5.00 <br /> 2. State Surchar�e � .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERitiIIT FEE (Add lines 1-3 above) $ <br /> The undersi�ned hereby applies to the City for issuance of a Sprinkler System Permit, a�rees to do <br /> alI�vork in strict accordance�vith 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 Date <br /> ***********************�*******************************************�************* <br /> Approved � Approved with Corrections Denied <br /> Revie�ved by: <br /> �� Date �� � — � � <br /> -�' P`�7^^�J�(� f'n J 5-T �Q-t �f f�..-s �r C o nnQ C.fi; d'1 <br />