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' !, ?� <br /> � �/ <br /> 'f� <br /> Please check one: New �Addition <br /> JOB SITE � �v �r�i s�-� � �rc� �' �� <br /> Owner's Name Telephone Number <br /> Mailing Address_ �5�,,.,,,�.. <br /> Sprinkler Contractor's Name�c r,�,-.�� �c��r�Telephone Number ��� —o?j'�� <br /> Contact Person ..J c r r-�-i ��, � <br /> Mailing Address G�;,�3' /�J<.;` �,� lY.,,�/�. �I.,.� � <br /> `VATER SUPPLY <br /> Lake Well�ity <br /> BACKFLOW DEVICE � <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers �„ ,�� /�G P y9 �� <br /> .�,;h.�;r,-? Lko 3 f`4 �o <br /> TOTAL �� <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: �3a <br /> Total Water Required: �j 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 Pernut, 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 /> Applicant Date �-/�- 9 q <br /> ********* * ** ********** *************************************************** <br /> � <br /> Approved Approved w' h Corrections Denierl <br /> Reviewed by: <br /> Date� `� ; <br />