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Please check one: �New Addition - <br /> JOB SIT$ ��� l��/�(/y1 �` � � , i <br /> Owner' s Name �� l��CJ�°� Te l ` � Numbe`r 3' �J� <br /> Mailing Address 3�� ��/�Glt` /l� <br /> Sprinkler Contractor' s Name/�fdw�f�-G��h �r���'Telep�fi�ie �`�Ju�nb�����✓7�� <br /> Contact Person �Cll'L�� �i�( �il�� <br /> Mailing Address �3�� �� (�� 7`f( N�U(�� �q�JIZ�/� �h• ���� <br /> ***tt****t*�***:*****��*******�****�*******#**** :*******#**�**#****�*****# <br /> CLASSIFICATION OF OCCIIPANCIES 1� <br /> Commercial Residential ��- <br /> ***�**#**�t**#*:********t�****�*:********�t********#********t***t**#�**t*t* <br /> WATER SIIPPLY <br /> Lake Well � City <br /> **�************************ ************�*:********t**�************�******* <br /> Year o� Crifice <br /> Make Model Manufacture Size uantit <br /> S rink ers 1q �r -J'0� '�''= 2 �'' �z � <br /> 10 = /,� G �'/ <br /> TOTAL <br /> **�*#*********�****************************�******#*t******�*************** <br /> HYDRAIILIC CALCIILATIONS Design Data: <br /> Area of Application: .S{C �'��t Sq. Ft. <br /> Coverage per Sprinkler: 3 r, �U, Sq. Ft. <br /> No. of Sprinklers : ,�.2 <br /> Total Water Required: �Z GPM. <br /> ***************************************************************�**t******** <br /> PERMIT FSE CALCIILATION <br /> l. Permit Fee $ 30 . 00 <br /> 2. State Surcharge. Based on valuation. $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FE$ add lines 1-3 above $ <br /> mhe �nd�rsigned hereb_v applies to the City of issuance of a Sprinkler <br /> System Permit, agrees to do all work in strict accordance with the <br /> ordinances of the City and State regulations, and certifies that all <br /> statements made on this application are complete, true and correct. <br /> Applicant �""���`�r "�1 �2r'ASL� Date ��� `/"l <br /> ******�********* ********************************************************** <br /> Approved Approved with Corrections Denied <br /> Reviewed b : <br /> � ��9�1 . <br /> Date <br />