Laserfiche WebLink
� ����o� 1.���� <br /> � <br /> �� i � �� <br /> Please ct�ck one: New V Addition 3 5� <br /> JOB srrE �� �/n T3 6 !�- N S 1��' r �v r f�' l�) . <br /> . Owner's Name l�� S S � P,� . Telephone Number — <br /> Mailing Address — <br /> Sprinkler Contractor's Name � ���k � �� 1� � (J�=1 C' ���Telephone Number �(�fc�"S���'^a �3 6 <br /> Contact Person � � �' � v , 1��" " '�` `' <br /> Mailing Address ; r;-° , -^ rr-1 �; r; �a. , k �.� � � .,� ,'`.� i , f�e � � <br /> u <br /> WATER SUPPLY ' <br /> Lake � Well City <br /> BACKFLOW DEVICE /Vc n� <br /> AVB PVB RPZ <br /> Year of <br /> Make Model Manufacture uanti <br /> � ,- <br /> S rinklers V►1 ° ^� I�' '-., <br /> • 1i�l�G�� /�'�c� 7 <br /> � �� <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: L- a w v, � .S� ,; v b f� e�cd Sq. Ft. <br /> Coverage per Sprinkler: /_�S jr���„ � � ,a Sq. Ft. <br /> No. of Sprinklers: � ` ` <br /> Total Water Required: � '� 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 <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on [his application are complete, true and correct. <br /> Applicant � '� � e "` � '� � rr^ ,' � Date <br /> ****�*****x��**�*�x*��*�*�***x��*****�**�*�***�******�*****�****�*********�x****�* <br /> Approved ��V Approved with Conections Denied �o '� g - � � <br /> � <br /> Reviewed by: <br /> ��`_ Date �� °��`' �� <br />