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5-�7-07 <br /> ��� f} ( 13S'� <br /> �5-�'3 � 3�� <br /> Please check one: New ��'"` Addition Limited Energy Technology <br /> � Systems License # f�,( G= '-CJ,j�� <br /> . � <br /> JOB SITE .,,� � `/C='' �lc-��l;,._ l�- = � c� y-� <br /> Owner's Name �-��,,�;�:,��� , Tel hone Number ���- <br /> -� '-►��-s � ��• y ?_ 3 _�..')���:� f� <br /> Mailing Address <br /> Sprinkler Contractor's Name � - c.., /� ,��,_�,.,�rTelephone Number )�.j- �r-j f �,S"��5-- <br /> Contact Person '„�s,� �n�. �,l -� /'/������T�� <br /> �s <br /> Mailing Address .�.�'� � ,�fj� '� �' � ��� / � �'S�-�-� <br /> n�.� � ��% .-, �<�i� ��t� � <br /> WATER SUPPLY <br /> Lake Well City�'" <br /> BACKFLOW DEVICE <br /> AVB PVB j-�""�� <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers ,�.,,,,tC,� f�;f� C� 7 `7 <br /> �,., ��- :���2� � <br /> � � <br /> � ..� f�,- �'"�l'�c�s �Y � ? �� <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: , ,�-,f� GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e <br /> $ .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 /> Applicant / ` � Date ,�'-l/'-,�- ���� <br /> *********�:** ***** ******** **************************************************** <br /> � . , <br /> Approved Approved with Corrections Denied <br /> Reviewed By: Date ��� ��-C� � <br />