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� ' �' _ {��5� <br /> �� <br /> Please check one: New Addition <br /> JOB SI'I'E ;; -� '� /^,, .-� ,�� ^�� � ' <br /> Owner's Name /��, ,,� ��'J��, , �s Telephone Number <br /> Mailing Address -,� � � -; �`''� /� <br /> ' � - =�5��.. <br /> Sprinkler Contractor's Name - _ i Telephone Number �� � 4 T <br /> .�- <br /> Contact Person � , ,-� / � ���r <br /> ,, �� ��� -�� <br /> Mailing Address 'i,�? ti /� < ,�-, �-'��%,, �� J�;„-, �`S�s <br /> WATER SUPPLY � <br /> Lake Well � City <br /> BACKFLOW DEVICE <br /> AVB PVB � RPZ <br /> Year of <br /> Make Model Manufacture Quantit� <br /> / . , _ � � _ � � <br /> S rinklers ' <br /> TOTAL � ' � <br /> HYDRALJLIC CALCULATIONS Design Data: Sq, Ft. <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: <br /> No. of Sprinklers: GPM <br /> Total Water Required: <br /> PER'VIIT FEE CALCULATION $ ;5.00 <br /> 1, permit Fee � SO <br /> 2, State �urchar�e. $ 0 <br /> 3. Mail-In Fee $ _ <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 /> � � ` Date _,_.�'._3_ `��l, <br /> Applicant - ` ` " � " <br /> ***�**x�*��****,*:***�****x�*******�*********�******�****************�**�*�***** <br /> �,prroved <br /> Approved with Corrections Denied <br /> Reviewed b : �� � / �,/ �' <br /> f�(/ ��l"�" Date l,� ��� <br /> .� <br />