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� ��e ��� <br /> Please check one: New �� Addition <br /> Jos srz� �7:5 c���-f��,� r����. �c <br /> Owner`s Name ��C���l� �.;��rn�;S Telephone Number y Qy -�(��, <br /> MailingAddress ��j Cf���-�'e�� � f<�2� <br /> Sprinkler Contractor's Name�jjv��Q�� �}�('^'�elephone Nurriber �-i�,�`-�25� <br /> Contact Person �jti f�:�1--� ��-r�'�nyy�c���-, <br /> Mailing Address��� L�J(��� n �' ����T- ��,C,,�� ►n L e , a�l� <br /> , <br /> WATER ST T P�LY <br /> Lake Well � City <br /> ��.CKFL.4W DEy� <br /> AVB PVB �_ <br /> Year of <br /> Make Model M�nufacture O anti <br /> �pri ers "j�C�:�� �Sv��-� �l`� �-I� <br /> Tar� �-i q <br /> HYDRAULIC CALCULATION� Design Data: <br /> Area of Application: _ _ �,� ���� Sq. Ft. <br /> Coverage per Sprznkler: j�����- I ZS(, �.,, ��� Sq. Ft. . <br /> No. of Sprinklers: y �} <br /> Total Water Required: �,�,,�, ,��, , �a„�� �� ����; GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge. $ .50 <br /> 3. M�� -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 grdinances of the City and State regulations, and certifies <br /> that all statements made o this applic aze complete, true and correct. <br /> Applicant � G Date nC,� �9- �� <br /> �k�k�k�k#�k��k�k�#-k�k�k�k�k#�k�k�k#�k�k�k�k�k#�k��k�k�k�k�k�k�k�k*��k*?���k��k�k�k�k��k�k�k�k�k�kx�k��k*�k�c�k�k�k�k�k*�F�k*�F��k�k�k�k <br /> Approved Approved with CorrecEians Denied <br /> Reviewed b . <br /> Date ' — <br />