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� '� <br /> ` Please check one: New `� Addition Limited Energy Technology <br /> Systems License # <br /> JOB SITE -� -��- �/�S - ,, <br /> Owner's Name �.� — ���,C!��� Telep one Number ���- ���-�,j,�� <br /> Mailing Address��'/�����<�-i r',S 7`��c� ,��.����i�/ <br /> Sprinkler Contractor's Name �,�/� Telephone Nutnber :;3�'��� t <br /> Contact Person �?,/�(� <br /> C <br /> Mailing Address - ��;���': <br /> `VATER SUPPLY <br /> Lake r/ Well City <br /> BACKFLOW DEVICE ' / <br /> AVB PVB ��l/� <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers_ tn�e 2 G �-��-141��•.D0� .�'J7/ <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design ata: <br /> Area of Application: ° 7 �S Sq. Ft. <br /> Coverage per Sprinkler: � �+p Sq. Ft. <br /> No. of Sprinklers: �t�_ <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. TOTALPERMIT FEE (Add lines 1-3 above) $ 3�.5 Ly <br /> The undersi�ed 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 /> � <br /> Applicant ' ����� �"� �� I, 0 <br /> Date � <br /> ***�*********�**��x**�x******�*�*********�************�***********************�**** <br /> Approved x App oved with Corrections Denied <br /> ._.. _ <br /> Revie�ved By: ���1� �� Date u 'i -� � <br />