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�u�-�4 ��� ��.4�Nm rrum �Ili ur uKunu +9522494616 T-168 P.003/003 F-280 <br /> t �, • ' �� <br /> . 1 �� <br /> Please check one. New Addition�_ �� <br /> �,� <br /> J'OB SI'1'� Z Sr� �d llaa h aC e V�l °� , w a�Z�y��� � <br /> T--�� <br /> Owuer's Name d l�e l� TetephoneNurnber qS1,-- l��y'..�}�3� <br /> Ivla�in�Addr�.ss '2 S�, - ���lc�`t a��r� a�, W��lZ�r�� �;��, �S 3�j/ � � <br /> , . <br /> Spri.nkl�r Contractor's Name S�tir 4�e r �y�$ �y c Telephone Number 952 r 9�L-/10�- <br /> Contact Persan h� ' <br /> Ma�in�Address ���/� l�) �-.7i .5�����K �I� s.��Z� ' <br /> �cvA��s�-P..� 2 <br /> Lal�e Well City (;' o`�e, b s��� P� �w ��'s���"~-\. <br /> 7 �� L��. <br /> B���D-"-�E . '� �-k `T_U _ ��, C.�.�.,�-��r�- ��0.{� � <br /> , a�va Pva � , . <br /> ' "Year a£ <br /> ake ode NIa ►ufacture ua i <br /> Sprir�klers <br /> , . - ., ' . �'aTA'�, ' <br /> gyp�tA�T.,IC CALC-CTX�ATI�NS Desig�Data: ' <br /> A.rea ofApplication: ���j�-� �I � ��� Sq. Ft. <br /> Covera�e per Spriz�kler: _ __ Sq. Ft• <br /> No. af Spt7nklers: <br /> Total Water�tequired: _ GP� <br /> p��12IT�,E� CALC�TLAT'T� . <br /> I, Permit Fee $ 35.00 <br /> 2, ,�tat�,urchar�e � -$� <br /> 3. �i�ee � � 1.�0 <br /> 4. TOTAX,�PE�'1�IIT�E (Add lines 1-3 above) � $ ..3 7 ,, ��_�— <br /> � ' The undersigned hereby appiies to the City far issuance of a Sprinkler System Pernut, agrees to do <br /> all work in sCrict accordance with the ordinances of the City axtd State regulatians, and certifies that <br /> all statements made on this application are camplete, true and carr�ct. � � <br /> Applican� . Date (�- - �- �� <br /> �*********«****�*� *******�*�***�****�******�**********��*�***�**�******��***�* <br /> Appzoved Approved with Correctians Denied <br /> I�eviewed by: <br /> Date <br />