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. . _;�l-�i �� 5 �-1 `1.� <br /> � <br /> � V� � 35 50 <br /> Please check one: New Addition <br /> JOB srrE /Co�� � �/L�� /� C�� ��/�,�la�n0 i��� <br /> Owner'sName ��1� /� �--C'..(���.�vL�-.�c�l TelephoneNumber <br /> Mailing Address <br /> Sprinkler Contracto�,s Name ',�in-��.�r�: �u�� �eT�ephone Number�1���S��IG—/ ��� <br /> Contact Person i �c ,' <br /> Mailing Address �37 1 Q /`�J i�cL�►�t� D� ��� �Dru��c�C,cp /�1L� �3'7� <br /> , <br /> WATER SUPPLY / <br /> Lake Well �/ City <br /> BACKFLOW DEVICE l L, �� ; �1 � <br /> AVB PVB � <br /> Year of <br /> Make Model Manufacture uantit <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: GPM <br /> PERMIT FEE CALCULATION <br /> 1. 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 /> ____> <br /> Applicant � ' � � Date �"" �`�—�a <br /> ********************************** �******************************************** <br /> Approved�_ Approved with Conections Denied <br /> Reviewed by: (,�� ' � <br /> " �" `°z. '?rr�—�. Date �' a-— � <br />