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_ . -� � I <br /> , / � � <br /> Please check one: New X Addition <br /> JOB SITE ,�� C.r�5� C-��k ��. <br /> Owner's Name � � � �������n • Telephone Number o�`��-I/!� <br /> Mailing Address _ `��� <br /> Sprinkler Contractor's Name �i��ss�u�� s��v,k�_ TelephoneNumber�7 Z-�9/9 <br /> Contact Person �E� (,���� <br /> Mailin�Address l S�7� (�� ��� W��w� � .��V- S�'���' . <br /> `VAT�R SUPPLY <br /> Lake `Vell�_ City <br /> BACKFLO`V DEVICE - <br /> AVB �_ P VB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers <br /> TOTAL <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: Gp� <br /> PER�I�IIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERiI�IIT FEE (Add lines 1-3 above) $ 3 $. SU <br /> The undersi�ned hereby applies to the City for issuance of a Sprinkler System Pernut, agrees to do <br /> all�vork in strict accordance with the ordinances of the City and State regulations, and certifies that <br /> all statements made on this application are complete, true and correct. <br /> Applicant Date �- ZD--� <br /> ***********************�********************�*********�**********��************** <br /> Approved � Approved with Corrections Denied <br /> Reviewed by: `� <br /> ,��%ttiC� Date 7- 24`c� c� <br />