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, <br /> c % <br /> �` ,G+� <br /> �;5 <br /> Please check one: New x Addition <br /> JOB SITE e. Q •-- � tY I'�/ V�S • <br /> Owner's Name � Telephone Number <br /> Mailing Address ' . <br /> Sprinkler Contractor's Name Telephone Number �j ' <br /> Contact Person V• <br /> Mailing Address �S��S �`�V�i1Y� 1 ll/' <br /> WATER SUPPLY � <br /> Lake Well X City <br /> BACKFLOW DEVICE <br /> AVB PVB RPZ �_ <br /> Year of <br /> Make Model Manufacture uanti <br /> S rinklers <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: �� <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 <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> . <br /> Applicant Date <br /> ****�******* *********** �***��*�*****x�******��******x�x�*�******************* <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> Date <br />