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. (/ <br /> �� � � � <br /> Please check one: New � Addition <br /> JOB SITE .�% J�, S � �,�� /� �����y � , <br /> Owner's Name `�''� -� Telephone Number <br /> Mailing Address ��� � S`� �� �r.���i ���� 4c--'=� ` <br /> Sprinkler Contractor's Name �� � Telephone Number � ���. `�Z/-�,� <br /> , <br /> Contact Person � I � !�• <br /> MailingAddress /�.d�. � ���d � � ��� . �1 ,5 �S ��� <br /> � <br /> WATER SUPPLY <br /> Lake Well � City <br /> BACKFLOW DEVICE <br /> AVB PVB �. <br /> Year of <br /> Make Model Man facture uanti <br /> S rinklers � -�- • �� � ��� <br /> . TOTAL G� <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: � � <�G Sq. Ft. .. <br /> No. of Sprinklers: / <br /> Total Water Required: �,� �'�'� �' GPM <br /> � <br /> /�.� ���ir�1 ��� �c7LP . <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e. $ .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 to <br /> do all work in strict accordance with the ordinances of the City and State regulations, and certifies <br /> that all statements made �this application are complete, true and correct. <br /> � _. <br /> .- , <br /> /�l � <br /> /:. - - <br /> Applica�t�,� �"� C � �' � � �_ Date � ../���� <br /> �Xx�������*��x���x�x�����x�����x���*�����x��*����x��x*��X*x��**x�x����x����X�*���*�x��x��xa� <br /> Approved � Approved with Corrections o� Denied <br /> Reviewed by� <br /> Date (, - � �t-11 <br />