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� <br /> iJ <br /> Please check one: New � Addition <br /> JOB SITE �O ct�a�, <br /> Owner's Name • Telephone Number — <br /> Mailing Address v a—c� <br /> Sprinkler Contractor's N e ? . Telephone Number / <br /> Contact Person <br /> Mailing Address <br /> WATER SUPPLY <br /> Lake Well � City <br /> BACKFLOW DEVICE <br /> AVB PVB � <br /> Year of <br /> Make Model Manufacture Ouantitv <br /> �pri�klers <br /> TOrrAL <br /> HYDRAIJLIC 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 /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge. $ .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 <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 are complete, true and correct. <br /> , <br /> Applicant .- Date <br /> **�*�**�***�x***�*�*�****x�****��*�*�x**���*********� *�*****�**��*****�**�**�**� <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> - Date �`�J� <br />