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, <br /> Please check one: New �� Addition <br /> JOB STTE � � �� ���,,� ��- i c���� %��-� �`� � — <br /> Owner's Name ro,{ Telephone Number <br /> Mailing Address � - - .,, s'i � <br /> Sprinkler Contractor's Name�?.-�r...,�� / � r-���< < Telephone Number �/'> > �,���"— <br /> �� <br /> Contact Person � T�� <br /> Mailing Address �� /-�__�Y� �� �-� , '% � �� /��` � '� <br /> WATER SUPPLY � <br /> Lake Well _� City <br /> BACKFLOW DEVICE <br /> AVB PVB _� �Z <br /> Year of <br /> Make Model Manufacture Quantitv <br /> � /`'G P �� � <br /> �nnklers r/n �4-r ' ` <br /> , <br /> TOTAI. y `-� <br /> HYDRAULIC 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 /> pE�TT �'EE CALCULATION $ 35.00 <br /> 1, permit Fee $ .50 <br /> 2. State SurcharQe. $ _ <br /> 3, Mail-_e $ <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 /> r ,� ' Date ��-/� � l"� <br /> Applicant � � `� <br /> *********�****�**�******** ***************�****�x*******x��******************** <br /> `� � Approved with Conections Denied <br /> Approved <br /> Reviewed by ��' / �%'� � <br /> � <br /> ,^//' -� � — �a�e � l:�`� <br />