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, ;�.2�� <br /> f <br /> Please check one: New �' �' Addition <br /> JOB STTE =���.'�'`���� � _� � <br /> — �� �'" �'i '��' �� �Xr c <br /> Owner's Name ,% �,� � �, �,=� j' . ,�y��;�; Telephone Number <br /> � <br /> MailingAddress c�.,�, Y <br /> Sprinkler Contractor's Name �,,_ ;,;�: ;�,, ! <br /> ` >r�, ;< <- Telephone Number ;��> 5 -�.�-,�S <br /> Contact Person . �_,- r-, � <br /> � <br /> Mailing Address ��.�T S- ' i i_> ' ` <br /> - �"Y%;,:, S-�' ��Y�� / <br /> � <br /> WATER SUPPLY <br /> Lake Well f/ City <br /> BACKFLOW DEVICE <br /> AVB PVB �=' <br /> Year of <br /> Make Model Manufacture Ouantity� <br /> �ri ers �,h � _, ��G i' 9� --,'`,L—_ <br /> �� „✓ ,��� /�-�J� � � / �l <br /> To•rai, �-� �C-, <br /> HYDRAULIC CALCtTiJATION Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. . <br /> No. of Sprinklers: - <br /> – �� <br /> Total Water Required: ��.��,,�,� � – GPM <br /> PERMIT FEE CALCULATION <br /> 1. Pernut Fee <br /> $ 35.00 <br /> 2. �tate 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 Ciry 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 /> � � / �� <br /> APPlicant ��. . �i, L Date 5��.� . ��s- <br /> ������*jK������x��,�����x������������������x�x���xx�������*��k����x��X�x��a���x*���� <br /> Approved Approved with Corrections Denied <br /> Reviewed by <br /> � _ .,-�'"� Date .,�".��(` <br />