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' . ► <br /> . � ��cF/�Fa <br /> U� <br /> . c jT�,o � �?p�S <br /> Please check one: New� Addition Limited Energy Technology F�R <br /> Systems License# �/�/� <br /> JOB SITE ���� �('X �,�'J"C���" <br /> Owner's Name Telephone Number 9S" -�Z�l�'� <br /> Mailing Address ��� �O k � , <br /> Sprinkler Contractor's Name �,�y11 �j�f�_ Telephone Number �/07-S"�1'�-,�7� <br /> Contact Person ,�1"� S <br /> MailingAddress �3l/f rJOh ��1�,--�(jf .q/ f,,.� -/1/��B /j?�1l .SS{0/ <br /> WATER SUPPLY / <br /> Lake Well ``� City <br /> BACKFLOW DEVICE � <br /> AVB PVB L'� <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers !/�,,�,f✓,� ,��'/? �s' Jrp ? <br /> i c� �w.r� r,...� n.,��� � �-,. 5 �A ►i . �s, �� � � � �� �l,�,�,�.>�� <br /> TOT�, <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: .ys"`Q��d Sq. Ft. <br /> Coverage per Sprinkler: /(o/J� Sq. Ft. <br /> No. of Sprinklers: S`�' <br /> Total Water Required: /S GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTALPERMIT FEE (Add lines 1-3 above) $ �'7. �U <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 ofthe City and State regulations,and certifies that <br /> all statements made on this application are complete, true and correct. <br /> Applicant ��'o`--- Date '�`-/-Oj� <br /> ********************************************************************************* <br /> + y �r�" <br /> Approved W `' Approved with Corrections 1..J1:�' Denied <br /> Reviewed By: �.-`�� i���' 1 '7 . .� <br /> Date � �'�' � <br /> Reset Form <br />