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. � <br /> t <br /> Please check one: . New L�Addition <br /> JOB SIT'E _ � ��� J.«<, �,� YY�;I/ �-/_ <br /> Owner's Name ��, -,.,�, ����t-,I- Telephone Number 9s-� - ��-- �,�� <br /> Mailing Address ��1;1s-o `_l.,.�M l,� r✓/�JI ��• <br /> Sprinkler Contractor's Name �C„�,y, I <�c.r v��..�Telephone Number 2l �- c��y;,;;t�rsr <br /> Contact Person �� r r-„ /�,.. <br /> Mailing Address ��/,�� �'Yi.�' ,:, �S� �-J. /'�-+„>� /�l ,;� <br /> WATER SUPPLY <br /> Lake Well_�City <br /> BACKFLOW DEVICE <br /> AVB PVB�� <br /> Year of <br /> » Make Model Manufacture uanti <br /> Sprinklers ,�/„ ,�_� PG P n,/ �v <br /> ,y� <br /> /T in.dir«1 �k�0 !'� y,� <br /> TOTAL Ss-- <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: �t�" <br /> Total Water Required: �� GPM <br /> PERNIIT FEE CALCULATION <br /> 1. Permit Fee $ 3 5.00 <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 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 correct. <br /> Applicant Date /�j� �/ <br /> ************ **** *************************�********************************* <br /> Approved Approved with Corrections Denied <br /> Reviewed by: � - � <br /> ��'`��7� Date � O � � � <br />