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Please check one: New� Addition <br /> JOB SITE � ��--d . <br /> Owner's Name Telephone Number <br /> Mailing Address �� <br /> Sprinkler Contractor's N e , ��. Telephone Number_�2;y�////�� <br /> Contact Person <br /> Mailing Address � / Gf/ ^ . <br /> � <br /> WATER SUPPLY \/ s S^35��/ <br /> Lake Well �C, City <br /> BACKFLOW DEVICE <br /> . AVB PVB_� <br /> Year of <br /> Make Model Manufacture u nti <br /> Sprinklers <br /> TOTAL <br /> HYDRAULIC 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 /> Z. 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 do <br /> all work in strict accordance with the ordinances of the City and State regulations, and certifies that <br /> all statements made on this application are complete, true and conect. <br /> Applicant /� Date � �' <br /> � <br /> ***********************************************�x**�x****** **** ***************** <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> Date� � <br /> , <br />