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Please check one: New Addition Limited Energy Technology <br /> Systems License # <br /> JOB SITE � 1�.. O /�'�-<-C� �'S�,�q�-7.1►.� <br /> Owner's Name �� ���� S�� Telephone Number (�� L— �UR—S^7d� <br /> MailingAddress .�jr,v ��l',., 9�'SL-' �%,.,��� <br /> Sprinkler Contractor's Name�L������D�vTelephone Number � S:L C-1�/C-,� 7t�� <br /> Contact Person ��`'7,7� �/,��5�jJ�n� <br /> Mailing Address - �J,� 5 S� f-��►>i J � GT ��,�-� SS3�� <br /> WATER SUPPLY <br /> Lake_1C' Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers 1��,,,�,��_ �C,� �� 3� <br /> �l�-,U-t�. ��� <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: /��d� Sq. Ft. <br /> Coverage per Sprinkler: �Zp� Sq. Ft. <br /> No. of Sprinklers: �_� <br /> Total Water Required: � L GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharee $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> The undersigned 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 /> Applicant Date <br /> *********************�********************************************************** <br /> �� <br /> Approved ,.'/' Approved with Corrections Denied <br /> Reviewed By: �� Date � '' ,� `�d � <br /> —� <br />