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� <br /> � <br /> Please check one: New !/� Addition <br /> JOB SITE ,����,3 ��„� cS�. <br /> Owner's Name ��� ,� �,� �a, r�— Telephone Number y� � -�1� gd <br /> Mailing Address f� �1S ,,��, � ��c . !�]` t� ���, /Y!n ��� / <br /> Sprinkler Contractor's Name � n�r.�.l .���v,�cx Telephone Number y� �- � S��,,�' <br /> Contact Person ` `�— <br /> !c C'r y � ���,'�L. <br /> Mailing Address G /� S /'�...'., � S�_ r�-c�1� ��.�,„ /Y7n �.S"'3�.s� � <br /> `VATER SUPPLY <br /> Lake Well �City <br /> BACKFLOW DEVICE <br /> AVB PVB !/� <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers , ,� ,,1�r /�G P Ov kU <br /> �?<.��;�.�c /Xov �o �o <br /> TOTAL /�o <br /> HYDRAULIC CALCUI.ATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: ,L�,o <br /> Total Water Required: 020 -�?„r' 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 /> � " � 'I <br /> Applicant Date , -a 7-vc� <br /> ********* ******************************************************************** <br /> Approved Approved with Corrections Denied <br /> Reviewed by: � <br /> ��� t���t.� Date �'.��--C� <br />