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r <br /> �. ' � � <br /> Please check one: New Addition (�' <br /> -l, <br /> JOB SITE _��j • � � <br /> Owner's Name ���C? ��,� Telephone Number 7 • 76Z ( <br /> Mailing Address �.�.Y�- <br /> Sprinkler Contractor's Name ���io ,��� vr���S�'elephone Number ?Z-j � <br /> Contact Person �� �.�� <br /> MailingAddress (S`�7� f ��� `.��'� ��-�"'���1 i'��• ��0� <br /> WATER SUPPLY <br /> Lake Well � City <br /> BACKFLOW DEVICE ��covr�.Q b� `A�e'� C°r`�"`�`�{�� <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Ouantit� <br /> �rinklers "b �� �� <br /> �-�v ?vv ?� <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 <br /> do all work in strict accordance with the ordinances of the City and State regulations, and certifies <br /> that all statements made n this a lication are complete, true and correct. <br /> Applicant Date - � <br /> *�*���*�x�*�x��x **�x��*����*�x�*****x���x�x�x��*�x��x�*�x��*x��*�**�k�x�x��**����*�x�*��xx��*** <br /> Approved Approved with Corrections Denied <br /> Reviewed b . <br /> , 4T' ' Date ��� <br />