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/ <br /> � <br /> . . ��a�s <br /> Please check one: New � Addition � . <br /> JOB SI'I'E <br /> Owner's Name �- elephone Number <br /> Mailing Address � <br /> Sprinkler Contractor's e � , . Telephone Number / / o <br /> Contact Person ��.... <br /> Mailing Address <br /> WATER SUPPLY ���-C�� i�'Cc�- S.�y� <br /> Lake Well � City <br /> BACKF'LOW DEVICE - <br /> AVB PVB � <br /> Year of — <br /> c <br /> TOTA,I..; � <br /> HYDRAULIC CALCULATION Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. -., <br /> No. of Sprin�clers: <br /> Total Water Required: GPM <br /> PERNIIT FEE CALCULATinN <br /> 1. Permit Fee $ _ 35.00 <br /> 2. State Surcharge. $ _ .50 <br /> 3. Mail-In Fee $ . -� <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) $ _�,�(� <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees to <br /> do all work in strict accordance with the ordinances of the City and State regulations, and certifies <br /> that all statements made on this application ue complete, true and correct. <br /> Applicant - Date �'2��� <br /> ��:���������� ����x��x���x���:����*������������:�����x�������x����x���x����x��������x����x:� <br /> ; . <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> Date _,�'"'�`'g� <br /> i <br />