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S • <br /> i � <br /> J <br /> Please check one: New Addition <br /> JOB SITE <br /> 9,5�� � <br /> Owner's Name��I�ti., ,l'j L�'Z i �I` Telephone Number �7(, " o��•:j� <br /> MailingAddress % �.5� �llo, /���nlo�io��. JQC�, <br /> Sprinkler Contractor's Name�,��� �;;o.-�iJ��,�e�' TelephoneNumber yS'�— �{��� c� 6 �� <br /> Contact Person ,�f�� L�, �o E�`Z�. <br /> Mailing Address %a 3 � o���'� f'���� �= ' S�ro�;a��- <br /> WATER SUPPLY / <br /> Lake Well ✓ City <br /> BACKFLOW DEVICE j <br /> AVB PVB ��� <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers /l�Q (.S v� /�i�d "�0�o �p 3 I �'�' j�v <br /> .�i���d,�'� f,�S ;¢0a � �o ( -�}- �✓ <br /> , . <br /> .i <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 /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <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 /> Applicant �� �/�� Date � � �� � o`�' <br /> *************************** ***************�************************************* <br /> Approved_�_ Approved with Corrections Denied <br /> Reviewed by: C>^� ��,�� Date b'2�—0� <br />