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- <br /> � � �v �D5�7 <br /> �-�5� <br /> Please check one: New Addition W/ Limited Energy Technology <br /> Systems License # ��_ =� �� .�} `�, � <br /> � <br /> � / ,, <br /> JOB SITE ��Z. �U ������CG .1 C ��L' �� � '�'l. <br /> �— <br /> Owner's Name �%t�' '`�J �k '� � � ¢`.C� Telephone Number <br /> Mailing Address ��� � �`"�"�:�v' <'� e%`E'�-��',� �,'�'' <br /> `, ` ' .' '._r ;,, r '� i <br /> Sprinlcler Contractor's Name � 'r; �, �. �,a�� rJ ���'=-i Telephone Ntunber ,����, ' '�r- ;, .. <br /> r .. <br /> Contact Person �>>'ti�. , r ��;;�-:-��_ <br /> M3111ri�1�dC1T8SS �s.� : • 1 .� �'��/.� ;_ ,=a/.�, i�'�1 �_ r�� � �L --� l� �� <br /> , <br /> `VATER SUPPLY <br /> Lake Well �� City <br /> BACKFLOW DEVICE ,/ <br /> AVB PVB • <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers-- �'��`r, �i/'c �"_ _ � '-�� - �,� : - ti' .3 � <br /> _ �Jrt��:_>� �_� ���ti:. -:: . �;> ,� ^�, ;y ,� <br /> TOTAL �- <br /> N aT S �� O!� �C TcJ A'� l v L r9 �-,a•� ,S - <br /> � ^-� ° 5 i �--e ►� f�tiJ <br /> HYDRAULIC CALCULATIONS Design�ata: <br /> Area of Application: Sq. Ft.� `t < <: <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 SurcharQe � .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 /> - � , �� ;✓ <br /> Applicant_ ��— ���� �� �� Date � - i1-' <br /> a%-' �_' <br /> � <br /> ******��*********���**�**********************�x******************�***********x�*� <br /> � ) �� <br /> Approved �� ���(,/�(,�ye� � e tions Denied � <br /> ���� , ,---- <br /> �_ f s�v� <br /> Revie�ved By: Date <br />