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� <br /> � �c:C�i�T �� U✓c f��G'1 <br /> Please check one: New Addition � � -� <br /> JOB SITE .--���'� ,L'"6��c'G�'C 7 C�c� c' G�_ ,��r���''�.�- <br /> Owner's Name /iL�G�. %_�,�j Telephone Number <br /> ,-- <br /> Mailing Address � ��� ���,-� c�i;'c°- 7 �" � .��� _ �<-�: � <br /> �,;:. � �_ i-�"� � %" ;�- -� ��� �S � <br /> Sprinkler Contractor's Name ;!r�i C�G�'���������- ����'���phone Number 5;���- -��'G-`/ <br /> � �: <br /> Contact Person �, �,���� �/= �ti �`;/ <br /> MailingAddress /%:�."��� �' � c��y Z�; ��z� �3/� �1 /�f�� c_ ��-. z�� _;— <br /> WATER SUPPLY <br /> Lake Well � City <br /> BACKFLOW DEVICE <br /> AVB PVB � <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers ����;�/�,�-� jc' > c> �-C. <br /> � � 1 y 7 <br /> /l G<r"�;"-'�i�' ' C, �U C;Ci ��'� , �C � � f-- <br /> TOTAL ,�/ �' <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: �� /,;-J ( .=' :�� r�s f/- � Sq. Ft. <br /> Coverage per Sprinkler: �J �/ Sqvu y �. � �- Sq. Ft. .. <br /> - , <br /> No. of Sprinklers: ,-- +- •. �, r ` � , =; i;��r� <br /> Total Water Required: � �U GPM <br /> � . . , , � , i. �,l.__�-^'�k,�J'/ \ <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge. $ .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 on this application are complete, true and correct. <br /> � _� <br /> �� � /� �� <br /> �� . <br /> _ . – �--` � �� - <br /> Applicant -�`" �' �- ---- Date <br /> C <br /> �k��k�k�k�k��k�k�;eac�c�k�k�k�k�e�e�e�k�k�k�k*�k��k .�k�k�k�FM�k�k�k�k�k�kM��k��k�X�k�kX��k�k�k�k�kXX�k�k�k�k�k�k�k�X�k�k�k�k�kM��k�k�k�k <br /> Approved I� Approved with Corrections Denied <br /> Reviewed by: (, <br /> '� ���.�.--_. Date b -1� -4 7 <br />