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f �. <br /> Please check one: New� Addition Limited Energy Technology <br /> Systems License# <br /> JOB SITE l �� ��.�IC�v i `� `S Tv W l`�" 1�OCJ�,O� <br /> Owner's Name r��l� Telephone Number <br /> Mailing Address �� l�v�C���S O�(Iil,'� - Y�,O�i.G� <br /> Sprinkler Contractor's Name J�/n`l'� �W�ql�pL�Telephone Number 4�����.�"c��� <br /> Contact Person `l�7/� <br /> Mailing Address C OJ� S i� S <br /> WATER SUPP Y �� '�'3� <br /> Lake Well�_ City <br /> BACKFLOW D VICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers��/— ���� �.0� � ��p _ <br /> TOTA.L 0 <br /> HYDRAULIC CALCULATIONS Desi Data: <br /> Area of Application: N ��� �7 Sy. Ft. <br /> Coverage per Sprinkler: � �-SZ� Sq. Ft. <br /> No. of Sprinklers: � l (o O <br /> Total Water Required: $ GPM <br /> PERMIT FEE CALCULATION <br /> I. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ L50 <br /> 4. TOTAL PERMIT FEE (Add lines l-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 ofthe City and State regulations,and certifies that <br /> all statements made on this application are complete,true and correct. <br /> Applicant �� L S Date���'"� ` <br /> ************ ****** **********************************�*********************** <br /> Approved Approved with Corrections Denied <br /> Reviewed By: ����✓�..C�- Date � � " � <br /> Reset Form <br />