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�/ �`.'� <br /> Please check one: New '� Addition <br /> JOB STI'E �n��j"� � +� <br /> Q�%r� �� <br /> Owner's Name ������ f��� _ �Telephone Number <br /> Mailing Address ���'� �ou.�11�-,� �r• l,.�i- "`����_ <br /> ,- <br /> Sprinkler Contractor's Name �,'�s� �,,�,<:p«ss�•--_S Telephone Number {j�� ' �`?� <br /> Contact Person � r � ^��- � ��- o •- �.l�,�r �� �- .,- <br /> Mailing Address ��"� �o�,� ��r�� i;f � ( l �G� �j J��G! 7 �� <br /> � <br /> WATER SUPPLY � <br /> Lake Well �� Ciry <br /> BACKFLOW DEVICE <br /> AVB PVB � RPZ <br /> Year of <br /> ake Model Manu acture uantit <br /> � � <br /> �rinklers , � � ��. _ �-n /� /� �' ,� <br /> 1?/�" hL�trc�'f�C � � <br /> t. � <br /> �ra�. <br /> HYDRALTLIC CALCiTLATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinl:ler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: �� � 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 <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 /> %� / i% �r�/� Date ��/ G,�l� <br /> Applicant �� <br /> ***��***�**��****��*�****��****�**���x�*��*�x*�*****�****��**�**�******�x����*x�*� <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> ,��� �%���� Date �� <br />