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, • . <br /> Please check one: New ��� Addition Limited Energy Technology <br /> Systems License# <br /> JOB SITE <br /> Owner's Name .� ���s �v�J �_ ��/ /'��° �;�� Telephone Number '�.• ��>- -- �� �' = - '�'�--�� `= <br /> Mailing Address j' �:.� /'.,� . � /`�T�? ^`i� l�`� %�� �.> � <br /> Sprinkler Contractor's Name /Q��(� u�,� l�����) ��.1 rw� Telephone Number ;��'� �� �Y�.%� - �' '� `�`� <br /> Contact Person L� � � �-_�� �`.G t�=�J <br /> � :- �/ / / � ��- � <br /> Mailing Address - �'-' �.' � �} ;�ll c/� ,a7�� r. . �. <, ,�, ,= f- ,� �� -� <br /> \. � <br /> `VATER SUPPLY <br /> Lake Well ;,, � City <br /> BACKFLOW DEVICE � <br /> AVB PVB � <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers � � � �i ; , . _ <br /> ,�'� h�,l?L (i�� <br /> �_—�� �,�°/`�� �' /S�� ��-- - � =i- � <br /> � <br /> TOTAL / � �� <br /> HYDRAULIC 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 /> PERI�ZIT FEE CALCULATION <br /> l. Permit Fee $ 35.00 <br /> 2. State Surcharee $ .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, a�-ees 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 /> �7 �� ,-, - <br /> Applicant Date ' � � � ' <br /> � � � <br /> �;� <br /> ***�**�***********************�********�************************************�**** <br /> Approved�_ Approved with Corrections �� <br /> Reviewed By: _�''�� � ,�V�--�_� Date �-� � —��� <br /> � '��r���"r '`'�-.� �?ec;' 'V �� • .. . <br /> �—Z� CPC`^��i t» <br />