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r <br /> �� <br /> Please check one: New Addition � � <br /> JOB SITE <br /> Owner's Name �i���i%�r� ��J,o�_f'- f/, c,f^ Telephone Number <br /> MailingAddress ��;a0 �cG�s �/ /�� �)�a '�Jo <br /> Sprinkler Contractor's Name iQ/��,_, ��',p�, ;u���� Telephone Number �� � 6 � R <br /> ContactPerson ,�✓��,�,�,�, �o��� <br /> Mailing Address c��.�C� ��.,�� /A U� ,(� . �Gt iP��l�'�� �/� � t�S�� ) � <br /> WATER SUPPLY ) <br /> Lake �� Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture ua tit <br /> Sprinklers ,/{��C,s o ,n.:� .f'�o rA���� �''� /1�/ 7 <br /> �l Jc�s v ,A.1 �,�-p f A,'�� �r% ' //r`f 7 ( <br /> 7'�'E�.. ..� <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: �'�.:� � � Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. .. <br /> No. of Sprinklers: <br /> Total Water Required: .Z�C GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge. $ .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 <br /> do all work in strict accordance with the ordinances of the City and State regulations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> Applicant ��' Date �� 7 <br /> *�*�x���x**����x����x�*����x�*��**������*x���x�����xa�*x*�������x�xx�x��xx���x �x�x��x���*���x* <br /> Approved � Approved with Corrections Denied <br /> Reviewed by: <br /> 1a� /�--� � � <br /> Date �' — <br />