Laserfiche WebLink
Jan-16-2003 09:58am From-CITY OF ORONO +9522494616 T-7T7 P.002/002 F-008 <br /> � �. <br /> � ���� � <br /> � ��� <br /> please check one: New� Addition <br /> �a�S� � S C ; ��a L .�_ ��o�o �'Ii� <br /> Owner's Name� D ,J G�a M�' Telephone Number �i� go y y�Y� <br /> Mailing Address_�.2-y-S C�C:A.a et.J�t �.n� • ��o�� . �9iJ/Y S..S3-�� <br /> T <br /> SprinklEr Contractor's lti'ame �� u c� C:� Telephone Number�/,�- gjo�-3�DO <br /> Contact Person Q K � <br /> Mailing Address�Q y � /������4�`ti �v t .�• ,�-���o :5.��.ss y�9 <br /> `4'VAT��i.S�Cl'PPLY <br /> La.ke _ Wetf� City <br /> BACKFLa`V Dl�� <br /> A'VB�� PV�3 � <br /> Year af <br /> 1�Iak� Model Manufac r anti <br /> Sprinklers <br /> �r r �t��vl�� ���a:/ <br /> � � � TOTAT. <br /> �iYDRAULYC C.ALC�IT�ATXnN� Design Data: <br /> Arf;a of Application: Sq. �'t. <br /> Co�verage per Sprinkler: __ Sq. �'t. <br /> Na of Sprinklers; <br /> Torai Water Required: - CrP1V! <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge $ , .50 <br /> 3. Maii-In Fe_ $ 1.SQ <br /> 4. TaTA.L P��2s'1�i�'�'E� (Add lines 1-3 abave) $ 37•b D <br /> The undersigned her�by applies to the City for issuance of a Sprinlcler System Permit, agrees to do <br /> aIl work in strict accordance with the ardinances of the City and State regulations, and certifies that <br /> all statements made on this applicacion are complete, true and correct, <br /> Applica�� � � --. Date /�' !!�'Z Oi'2O0�j <br /> � <br /> �*�*%�*�k*�k*�k�k��k��k*��*******�k*�M�k*�*k*�ka�*:k��k****A�*�k�k�M�k****�******�**+k**�k:k**#**:k*:k�:�* <br /> Approved /�'�� A proved with Corrections Denied <br /> Reviewed hy:�� y_��._p� <br /> ,, �-ri.� Date <br /> �/\t� '�S4�C r:O t� wt:,� (c c�P 1�r: U f'�, <br />