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• <br /> Please check one: New Addition � . <br /> ' � c-: ,-- <br /> JOB SITE �> �-' % �C� f'� ��U'%�L � - <br /> Owner's Name ��G j�? �Q �, �,�C�? Telephone Number <br /> Mailing Address S � <br /> Sprinkler Contractor's Name --<<, �r ;,.:t _ Telephone Number � .� /� � <br /> Contact Person � � �-. ,, <br /> Mailing Address / `� ,.�..., '- a.�, %t.� �t �. ` F �_�� � , <br /> �o.l <br /> WATER SUPPLY � . S S S�-(�/ <br /> Lake Well � City <br /> BACKFLOW DEVICE � <br /> AVB PVB � <br /> Year of <br /> Make Model Manufacture Ouantit,� <br /> Sprinklers <br /> TOTAL <br /> HI'DRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. �, <br /> No. of Sprinklers: <br /> Total Water Required: GPM <br /> �ERNIIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge. $ .50 <br /> �" 3. Mail-In Fee $ 1.50 <br /> � 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> ti, <br /> , - <br /> �� The undersianed hereby applies to the City for issuance of a Sprinkler System Permit, agrees to <br /> �` do all work in strict accordance with the ordinances of the City and State regulations, and certifies <br /> ^' that all statements made on this application are complete, correct. <br /> -, <br /> , <br /> . � J / — � �j <br /> Applicant Date _ �� ��1�/ ,�1 <br /> �k��kr;c�ei,c�;e�$c�;ex$c$c�c3��[exa;e3e$c$c�;c�k�k�k�k������k�FX���k�X�C3�ic:ks;c$cxa;chc�c�c�kac�k�C�c�cxachc�tcs,c�e3cx3,c3,ci,c�c$exe�c�eac�4$c�F3i�K <br /> Approved �''"" Approved with Corrections Denied <br /> Reviewed by: _- <br /> � . <br /> � . _��",� Date �� � <br /> Y <br />