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� Please check one: �New Addition - <br /> � � �? <br /> JOB SITE �� �f S� �=�h�1�.�5 ���%�i.'T 1r �`�'�1✓ <br /> Owner' s Name ��L:'� �� � Telephone Number �l��- �'�`� L <br /> Mailing Address �� `/S� ,�=�N/��S /�����T t����'�'i/ <br /> Sprinkler Contractor' s Name .�i��'t!� t��x Telephone Number Gf'1/- ��7�� <br /> Contact Person ��G��'U �`v� <br /> �� <br /> Mailing Address /�'%S� �"�f''�' � l�t�%''`�%T ��'�� <br /> :********t*****:*****�**�*:�**�******************::**********�***:*�******x <br /> CLASSIFICATION OF OCCIIPANCIES <br /> Commercial Residential ,�_ <br /> **�*##*****�***:#***::*****t*#******��#*:�*t#************:�***t****#******* <br /> WATER SIIPPLY <br /> Lake �_ Well City <br /> *******:********��*************�*#***********�*:*�*****:t**�**�**t********� <br /> Year of Orifice <br /> Make Mode 1 Manufacture Size uantit <br /> prink ers -�S/ T � J 3/i�_ � � <br /> ,7�1�i h/ %,�1� �`f� -��it, z" <br /> TOTAL <br /> *****��**********#*********:****************************�***************�** <br /> HYDRAIILIC CALCULATIONS Design Data: <br /> Area of Application: 3�?• �-� �' � Sq. Ft. <br /> Coverage per Sprinkler: i, � � :� Sq. Ft. <br /> No. of Sprinklers: J`� <br /> Total Water Required: �y GPM. <br /> ****�********�**t�*****************�********t****************************** <br /> PERMIT FEE CALCIII�ATION <br /> 1. Permit Fee $ 30 .00 <br /> 2. State Surcharge. Based on valuation. $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FE$ add lines 1-3 above $ <br /> The undersigned hereby applies to the City of issuance of a Sprinkler <br /> System Permit, agrees to do all work in strict accordance with the <br /> ordinances of the City and State regulations, and certifies that all <br /> statements made on this app lication are complete, true and correct. <br /> � <br /> , ---� <br /> f� � � ��� <br /> Applicant ���2' �� � _ Date � � � � <br /> *************************************************************************** <br /> Approved v Approved with Corrections Denied <br /> Review d by: <br /> �J'.../�.��,�-J 7--3--�� � <br /> Date <br />