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� � � �.-� <br /> -;� <br /> Please check one: New L,�Addition � <br /> JOB SIT'E �( ��cJ �-�_/;-,�.--�„�. ,�o�/, <br /> Owner's Name G�,/v /�' Telephone Number <br /> Mailing Address <br /> Sprinkler Contractor's Name ���. ;,,� �-t� �r. ._�-,� �Telephone Number , �-� s"-- <br /> Contact Person _.�C_� r y � ,,� � <br /> Mailing Address /-: �� �� �., �, S'� �l�J, � /��,�,r; <br /> WATER SUPPLY <br /> Lake Well ��City <br /> BACKFLOW DEVICE <br /> AVB PVB �/��� <br /> Year of <br /> Make Model Manufacture Ouantitv <br /> Snrinklers f��,..� �- f'�P S � a v <br /> w ir�. �i rv� !�b y � � l� <br /> TOTAL �a <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. . <br /> No. of Sprinklers: <br /> Total Water Required: 7,f- GPM <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 on this application are complete, true and conect. <br /> �� / - <br /> Applicant Date o'� �' 7 <br /> Xc�c=kx$ci,ci,cre�e�e;c�e�k 3,e $eaex$c icac�4x�k�k���k�k�k�XM%k����k�k?���K�k�k���X���k�k����k�k�k���k���kX3i���k��k��k�k�k� <br /> Approved ✓ Approved with Conections Denied <br /> Rev' d y: ' , <br /> ���� Date � �= � <br /> , � <br />