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. . v, <br /> Please check one: New_� Addition Limited Energy Technology <br /> Systems License# <br /> JOBSITE ��St7 � �} `{ pLAC'c �` � YZ�1-%/� M� ��i� <br /> Owner'sName �-��Hy Pi 2 TelephoneNumber � - ��3 <br /> Mailing Address � � �L��/ �L/�-�� <br /> Sprinkler Contractor's Name -�—��,� Te�ephone Number_ �o(2 -�Z j -p�3(> <br /> ContactPerson ����rf/ ��9-M�i`y2 <br /> Mailing Address_ • ���Q Z.��/ PL.�� <br /> WATER SUPPLY <br /> Lake- �� Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers � �Jz' �p <br /> �Q6�1 �If� <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: �OC� Sq. Ft. <br /> Coverage per Sprinkler: �p Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: ��: GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .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 t ' application are complete, true and correct. <br /> Applicant Date r� -(�� -D 3 <br /> ******************* �******�� ******************�***��x�************************** <br /> Approved � Appr ved with Corrections �� <br /> Reviewed B : �� i <br /> Y Date I U� - �� <br />