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Seo-11-200J 12:48pm F�cn+-CiTY b� ORGVC +9522d94616 T-572 P tiO3/003 F-291 <br /> { � <br /> � Flerse check oxae: Ne�,v�_ X Additian <br /> JOB SI'Tk� 2,1UU Go er \I,e:.i: 1�:. <br /> Owner`s Name_�ry � `�. ,N k.�' � TeI honeNam � <br /> 1�' ep � bes�la�- 7ytv9 <br /> Mailu��Aciciress Z�Gp (/�',���",� ` (� , <br /> ��(�VL —V 1�_ ,_�__. . . . <br /> Sgrin}c:er f;ontra�q�'s l�am.e �;�n � YV��u��.��} __.__ TelepharbeNumber `ilv3- �-IZC�- .9�( <br /> Cont�ct T��tson `1_0� �F�► ec' <br /> �-_.��_--- �. <br /> Mailin�Address i�c______��`,�1i� i� �a rov ►M N SS � . <br /> ��--�-�-��-..� 3 i <br /> �VA�Y�'�'PLY l� <br /> �,ake_-- 1�Ve�1�C Ciry <br /> ��?�,o.,.. ti_.. �►�'.��;VICE <br /> �v� �. �vs X_..� <br /> Y�ar of <br /> �I j�e Model �an�facture uan ' <br /> Sptink2�rs `T�or �-100 _ 200 <br /> ------- --_.,. ��o� s�� _.m Zcaoo �...�� <br /> --- ---�--- <br /> -_,..__ ,�,UTA�,��._�_ <br /> �iYI)R�LrLIC CA_..LC�'Y.AT I�'S T}�Sign D�t�' <br /> Area of AppIicataan; �--• - �2, e qp �q, Pt. <br /> Coverage per Sprinkler: ���� ��Sq, �t. <br /> No. oi'Sprinklers: c�� � <br /> 'rocai��'arer fiequire�?: --_T...�`--_�'�...-.�'____�3__.��yl <br /> PIER�4i]CT �"�,�� C�►X,,C,;ULA'T'ION <br /> l. Peamit�'ee � <br /> '�`, �te Surchaz�e S aS.Oa <br /> 3. �il-In Fee � --5� <br /> �. '1'[)TAL F��'.:'4�II7C FEE (Add L'nes g-3 above) � � 3--7 . �c: <br /> THe und�rsiQned hereby applies to the City for:�suance �f a S�rinkler Sy§.err�P�em�it, agrees to do <br /> a�work in stric; �ccoadance witn the orcYinances o�the� City and. Stat�reguIaticns, and certifies that <br /> a!I sia�em,erts m�de on tt�:s �p�licatien are comple;e, true and cc�rrect. <br /> Applicat�t __. . Date �-/,Z- p� <br /> �` - - ._. <br /> *�M##**i*W�hxW#�h1�.k��b�N**k**�Y*�k �r�*�M*4****�Mw***+k#�*�N�N�*�k�h�N***�li��M+kM#�F**#*�***�***+k+k*+M <br /> Agproved_� A roved with �:arre;:tac�ns__ �e1y� <br /> . <br /> R�viewed by: <br /> � ��� <br /> � '�„9_ � �_T__--_________--------�— Oate,r�'(�"a� � <br />