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. _ ' . � �b 3�$ <br /> Please check one: New � Addition � <br /> / <br /> JOB STTE Gc�rc.� <br /> Owner's Name • Telephone Number <br /> Mailing Address <br /> Sprinkler Contractor's N Telephone Number ,� / a <br /> Contact Person , <br /> Mailing Address � <br /> WATER SUPPLY <br /> Lake Well � City <br /> BACKFLO`V DEVICE <br /> AVB PVB � <br /> Year of <br /> Make Model Manufacture Ouantitv <br /> Sprinklers � <br /> TOTAL � <br /> �II'DRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. , <br /> No. of Sprinklers: <br /> Total Water Required: GPM <br /> �ERMIT FEE CALCULATION <br /> 1. Permit Fee $ �5.00 <br /> 2. State Surcharge. $ .50 <br /> 3. Mail-In Fee $ 1.50 <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 rewlations, and certifies <br /> that all statements made on this application are complete, true and correct. <br /> . , <br /> Applicant — Date % — <br /> ok�k�k�k�k�k����k�� �k��k������k�k�k���k���k�k������k����?���K�cxx�;c$cx���*�k**��k�k*�C�k�;e�te���k��F��k�*���k� <br /> Approved Approved with Corrections Denied <br /> Reviewed by: �� <br /> Date — <br />