Laserfiche WebLink
.+� . ��5��� <br /> Plea .; check one: New V Addition Limited Energy Technology <br /> ,�'' " Systems License # L c� �� 3 `�' <br /> JOB SITE /�o�.�� �a 6;NS /-�, /�C� � c.�!� �- nJ� <br /> Owner's Name_�� (' e /' /�o V �� r y� Telephone Number <br /> Mailing Address l���v �'o �f„�S �j, iQ�✓ � ''G J���� <br /> Sprinkler Contractor's Name .�j,^�.t�-P Go ��z_. Telephone Number 7�� �`�.S � 6 `r �� <br /> Contact Person j/�c%�� <br /> , ,�/ <br /> MailingAddress � ���e , ����:N�< �'�.�'' j�'�' `{_ ��./:� ��r� . �� �IJ� �<-�/n c�P /'7l�/- <br /> WATER SUPPL �S—3 �7 � <br /> Lake Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers /�/E'(J o�'J /%.o �,'o o ° v�n�3 /�� �., <br /> i/'r��7`�c � ��' �-r��� _� o � �� �� <br /> TOTAL <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: GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ -- }:S�p-- <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 /> � � <br /> _Applicant �� D�e � — " G <br /> � �� <br /> �*************************�**************�*�x*****************************�**�*�** <br /> Approved M N pr ed with Corrections Denied <br /> Reviewed B : �����lJ�\ �3(:' Date ��Z�_� � <br /> Y <br /> _ _ _ _ _ . _ _ _ _ _ _ <br /> _ _ _ _ __ _ _ __ _ _ _ <br /> . _ _ _ . _ . _ _ _ _ _ _ ___ _ <br />