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- �� �oia _ o0 9�S <br /> . - � � � io -3- /Z <br /> s�ss oZ� <br /> Please check one: New� Addition Limited Energy Technology <br /> Systems License# ��_4i0���� <br /> JOB SITE �o�4 5 �<<-�c��-�'� �� <br /> Owner's Name ��� �v�1 , �� � �� Telephone Number `���,--`i'���''7�3� <br /> Mailing Address ( '2 t� fj �j������ti S� <br /> SprinklerContractor's fe 'v:� `_.�+�;�'�� Telephone Number 15� - `I "� �� � <br /> Contact P '� � � � <br /> erson ��� <br /> Mailing Address - p � L ^ (�,��� � 1`"�� <br /> WATER SUPPLY <br /> Lake Well� City <br /> BACKFLOW DEVICE <br /> AVB PVB� <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers �'L,� �j;� �; � � <br /> -�v � •Z� <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: '��G Sq. Ft. <br /> Coverage per Sprinkler: � � �� ' �t. <br /> No. of Sprinklers: �Z. <br /> Total Water Required: � �.. � �- � GPM <br /> PERMIT FEE CALCULATION � ��� �— ���� <br /> � D'� <br /> 1. Permit Fee $ � J`�� <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 /> A licant " � � ..� _ <br /> pp Date f� `� �t� <br /> ************** **** *************************************************�******�*** <br /> A roved � A <br /> pp pproved with Corrections D�� <br /> Reviewed By: � ~ _ Date � � <br /> �V � ' � <br />