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' � � c ' <br /> - � ���9� ��s� <br /> � Please check one: New Addition Limited Energy Technology <br /> Systems License# f�� ��% � <br /> JOB SITE ��,.��� <br /> Owner's Name ��j�►') �L�/�1 Telephone Number y,�c�"''�v�� ' �vCJ�7� <br /> MailingAddress �p�p0 ��_ ��v✓�o <br /> Sprinkler Contractor's Name G'i'� � v�-� .� �1v✓G�/_,�-�Telephone Nun�ber_��� <br /> Contact Person �% . S` /�"itl�- �1G �'/J-'3��1 ./3�/ % <br /> MailingAddress S1 /.� ,��c✓S�Y'�: �.1�• /l�.4 �- ��h,/YI� y <br /> WATER SUPPLY <br /> Lake Well City <br /> BACKFLOW DEV E <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers �e ��y ��� vZ c� � -a�� <br /> r ,�- �b � f7' <br /> �roTa� <br /> HYDI2AULIC CALCULATIONS Design Data: <br /> Area of Application: _ _ Sq. Ft. <br /> Coverage per Sprinkler:��� 'y -� �a� S;7r�c.�l S Sq. Ft. <br /> No. of Sprinklers: �'� <br /> Total Water Required: a-C7 GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ I.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 ofthe City and State regulations,and certifies that <br /> all statements made on this application are complete, true and correct. <br /> Applic /''��/" �/ Date���Q�— <br /> **************** ********* ***********************************************�x****** <br /> Approved �' Approved with Corrections Denied <br /> Reviewed B �: ' � �~� <br /> y �,��,��� Date '� <br /> Reset Form <br />