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a <br /> r <br /> �.-l�i`�� <br /> y <br /> Please check one: New _� Addition <br /> JOB SITE � �S�S� �o+-�n�rv ��c�c��r`. <br /> Owner's Name Telephone Number <br /> Mailing Address s��,-,� <br /> Sprinkler Contractor's Name G��.,.! c�rv;� Telephone Number y� g -�S�S <br /> Contact Person �_ <br /> �r{'/ �� w�nc. <br /> MailingAddress ���5 /'Yl.�•n s�• /y�'D jc ,� ,;,� <br /> WATER SUPPLY <br /> Lake Well _� City <br /> BACKFLOW DEVICE <br /> AVB PVB J� <br /> Year of <br /> Make Model Manufacture Ouantitv <br /> rinklers � <br /> � %� �d`-1 <br /> TOTAL c.�b <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 /> Applicant � Date �_�d ' 9 7 <br /> *�x�*�*��� x�' .�x��xxX �x�*�x���**� �x��*��x*�x��x�x*��x��x*���**x�*x�����x��*x�x���x*���*��� <br /> Approved � Approved with Corrections Denied <br /> Reviewed by: � <br /> Date --' -� <br />