Laserfiche WebLink
oZdo9- d�d� <br /> .. �7. �° <br /> - Please check one: New�_ Addition <br /> JOB SITE - � �,(j ' l�� ��� . <br /> Owner's Name �.J ��. ' TelephoneNumber�cJa- (��3-��-'7� <br /> Mailing Address �C' ��l� � <br /> Sprinkler Contractor's Name��{,,�I�t;� ��I,u�`� TelephoneNumber �(G??���'�9 -3�,a I <br /> Contact Person ��iY'' � � � ' v1 ���- ' �,C —7� <br /> Mailing Address ���5 �Y�c�-l1�'�-��t q� �� , � �l �� 1�4'1 �l� �cj�`7�j . <br /> t <br /> `VATER SUPPLY <br /> La.ke Well � City <br /> BACKFLOW DEVICE <br /> AVB x P VB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers �,�,� l�� ���� 3s- <br /> - TOTAL �S <br /> r <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: � ' Sq. Ft. <br /> No. of Sprinklers: 3 S <br /> Total Water Required: _ ` � Gp� <br /> PERMIT FEE CALCULATION <br /> I. Permit Fee $ 35.00 <br /> 2. State Surcharse $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERitiIIT FEE (Add lines 1-3 above) $ �37 ,��,� <br /> The undersi�ned 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 cectifies that <br /> all statements made on this application are complete, true and correct. <br /> Applicant �G�' k /.Gj1, Date - ' -c <br /> _ � �-�-�1 � � <br /> ***********************************************************�********************* <br /> Approved ✓ Approved with Corrections Denied <br /> Reviewed by: ^ � �1�� f�� °�,--� (�- L��' <br /> �'� Date <br />