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� <br /> Please check one: New �/�� Addition . <br /> JOB SITE o��Sl.� �� �is.�J i�(.- 3- �-�/ <br /> Owner's Name Telephone Number <br /> Mailing Address � f,",.� <br /> Sprinkler Contractor's Name G ,,� „`/ � S �,v;� �Tele hone Number � <br /> P .,/�-� -�2 S-�,�^ <br /> Contact Person �- <br /> �-r rrv �/'ya�� <br /> Mailing Address �t�� �.y,y�,t;,., � S'� �-7�,,, � ffl j,,�,y <br /> WATER SUPPLY <br /> Lake Well ✓ City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> S�rinklers �/.�,..,,�r �G� � 7 � � <br /> ,�.�;h 1�.� i�o y S� �?� <br /> To�rai, �/ 3 <br /> HYDRAULIC CALCULATIONS 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. Permit Fee $ 35.00 <br /> 2. State 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 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 rewlations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> , � <br /> Applicant =_ � ' Date -oZ�f <br /> � ,� � v <br /> �k�k=k�k�k�k3e�k����k3��c �k�k�kae�k�k�;e�!c�k�k�k�k�k ���4�e�k�?<���xx$e�;c3,c�k��k�k��c3,e�F�k�k�;e�k�$cx$c�;e�(c�?e3e�k�ki,c�k�;c�k�k� <br /> Approved Approved with Corrections Denied <br /> Review d <br /> /'/' � � .� <br /> �� �' Date ` � <br />