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� � <br /> � �� ��y3 <br /> Please check one: New � Addition <br /> JOB SITE �� 1S �'.-�...r►frY t,�� /'�r�- W. <br /> Owner's �'ame Telephone Number <br /> Mailing Address �,.,.� <br /> Sprinkler Contractor's Name �ch�.+.�/ , �c r��.c� Telephone Number �{)������ <br /> �- <br /> Contact Person �r�_��,.�� <br /> MailingAddress �j�_S �/��J,�.;, S'� />�•�A 1�- /al�.;,� �.3-�`3s� <br /> WATER SUPPLY <br /> Lake Well _� City <br /> BACKFLOW DEVICE <br /> AVB PVB _� <br /> Year of <br /> Make Model Manufacture Ouantitv <br /> Sorinklers ,�h�-� �G � � 7 � <br /> TOTAL � �v <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: GPM <br /> PERMIT FEE CALCULATION <br /> l. 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 regulations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> ( - � � _ <br /> Applicant Date 7- � � 7 <br /> T� ��" <br /> �k�k�k�k�k���k �k �k�k�k �k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�R�k�k*�k�k�k�:K�kx�cxi,c>k�k��k�k�k�k��k��k�k�k��k�k�k*�k�k�*�k�k�k�k��k�k�k�k <br /> Approved -- Approved with Corrections Denied <br /> Reviewed by: � - <br /> � Date ���� <br />