Laserfiche WebLink
` Please check one: New %i� Addition <br /> JOB SITE �G�,S S ��--< ,��� r��r :S %6�C�� %�, _ L�v . <br /> Owner's Name ���,-� � Telephone Number <br /> Mailing Address �Z�. s s' ��,-„7�C. ,, c;�/T l�a l / _S���s' L <br /> Sprinkler Contractor's Name ��- f,�_,-�,,�� �S'�-,-c ;� < Telephone Number �� � ��-�_s"-S S r <br /> Contact Person `�^ <br /> (r i�r y / /h-, t� c- <br /> Mailing Address l'� S- �,��� . � . S�. ��'��.� l /�/� .` S` S` .3 S�- .� <br /> WATER SUPPLY ' <br /> Lake Well �'' City <br /> BACKFLOW DEVICE <br /> AVB PVB � RPZ <br /> Year of <br /> Make Model Manufacture Quantitv <br /> �rinklers �h,�� �� - �� t� %C, �.�' <br /> TO'TAL ;�,S� <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: -�,�, _ ��c, _ Sq. Ft. <br /> No. of Sprinklers: ��= <br /> Total Water Required: GPM <br /> PERMIT FEE CALCULATION <br /> l. Permit Fee $ 35.00 <br /> 2. State Surcharae. $ .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 <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> > <br /> /,, _ \� <br /> Applicant � Date ��- � ���= <br /> �: -� <br /> ********�*x�** ***** � ********x����*****�*����*****x���x*���*�*�**x���****����***�* <br /> A roved"/ Approved with Corrections Denied <br /> PP <br /> Reviewed by: 0� /� �y <br /> � Date �C�4�`��� <br />