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. ` ���� ao37� <br /> � � C��.� ��,.� _ <br /> � � � � <br /> , <br /> � � <br /> Please check one: New �Addition Limited Energy Technology <br /> Systems License # E�r..v1,i i �a <br /> JOB SITE .3D CDC� �"�t y^�%, z�,.�; �..�•ti�� <br /> Owner's Name��c v, �j �i d:�.��'S� t �i c•� Telephone Number C�/Z ��/G ,���/G <br /> Mailing Address .3G=[c�:. �C'��,���;z�: i...��,t� G('c-L1- �.� `'-(c, <br /> Sprinkler Contractor's Name ,�r,�,,:,��,,,T,r,L � ��� ���zF'e1�pl�one Number �v l Z3Lc�?�-Z��Cc � <br /> Contact Person ���v�. � �-�� ' �� � <br /> Mailing Address - � 1��G� c c=,�,.,�-�..� ��;`� 1'-� S � <br /> 7�� ��'�.,�r� 1��� �`l SS ...�� Z�� <br /> WATER SUPPLY � <br /> Lake Well� City <br /> BACKFLOW DEVICE <br /> AVB PVB _�- <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers �,'� ����,C , �7I��</ Zc=�� �� C�S <br /> Z�t� �t �; f�l 1 �cry�l z��-� <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. ofSprinklers: � -- � r'r-��c-�c ���r =���1�rr�,� <br /> Total Water Required: /�i — �'Z_ 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. TOTALPERMIT 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 i J •=-��� � Date � ' --U�' <br /> ****************** *********************************************************** <br /> Approved Approved with Corrections Denied <br /> Reviewed By: � � �����, � ��� Date 7-�� -G�'� <br />