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'�� �5 �_ �C��,� - <br /> - ,� � LU��Z <br /> � <br /> Please check one: New�_ Addition Limited Energy Technology <br /> Systems License# �'S Qp 5 7 3 <br /> JOB SITE <br /> Owner's Name ��_��AS ►�o�o.�. �t�n�'�"� Telephone Numberq�jZ,-�7 L'7 3 0� <br /> Mailing Address ����"j ��q� �,�,f,a � - � _ p�,.��rn n $�3�� <br /> ����— <br /> SprinklerContractor'sName�Tri�klcr SvS�... ��„�'elephoneNumber�CSaqa-a.�aba. <br /> ContactPerson ���,� ���,�o,,� <br /> Mailing Address���{( �-�c�b�ra �.,j m�.K�, m , � ,r-,�3 O�S_ <br /> WATER SUPPLY <br /> Lake� Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers �;,��;�.9 ��pp q�.�� � �.� <br /> _ •r� �c 2 �e o1 <br /> 1�a.�v�. �►i-cQ 1'3t�0 A -1r od� � <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: � t��, <br /> Total Water Required: L r.2ae s zo,.� � � �Z GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .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 /> \ � <br /> Applicar�it� `"�� Date � - �—Q <br /> **************** ************************************************************* <br /> Approved Approved with Corrections D�� <br /> Reviewed By: ����t✓C�t�(J Date �- � �'� � <br />