Laserfiche WebLink
. �� � � �L <br /> Please check one: New�_ Addition <br /> � <br /> JOB SITE �� L r� �'�� Z�'�..� � � . <br /> Owner's Name 1 ������� �,�.� � Telephone Number �'� � 2�' ���� <br /> Mailing Address ( Lf C� �/�K � ,� _ � /1 � S � (� � f�-��`�/?�-�� <br /> Sprinkler Contractor's Name �-C Se� �i<<�. � �� TelephoneNumber � �'�-U��-2 <br /> Contact Person f' � ��� � <br /> Mailing Address �>. �a .� v ��; ��l .S-S � 27 � <br /> `VATER SUPPLY <br /> Lake Well � City <br /> BACKFLOW DEVICE <br /> AVB PVB � <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers ��i�.�.�� ��v �1��9 �-S <br /> � <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: ,.� �C� Sq. Ft. <br /> Coverage per Sprinkler: � Sq. Ft. <br /> No. of Sprinklers: ��5 <br /> Total Water Required: ��b GPM <br /> � <br /> PERMIT FEE CALCULATION <br /> l. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .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 do <br /> all work 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 /> � � g <br /> , / <br /> Applicant � � Date / <br /> ********************** ************************�********************************* <br /> Approved ;� Approved with Corrections Denied <br /> � <br /> Reviewed by: ; <br /> w� �f:G Date �"�--`l,% <br />