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-� , +�- .�'` r����'� �`� 3 <br /> = _ ��� _ �/����� <br /> Please check one: New� Addition Limited Energy Technology <br /> 27�G,' K�� t,� PQ r k�� Systems License # <br /> JOB SITE - � (Z/�l�Q'L`-- �� 1 -+- d I� , <br /> Owner's Name a Telephone Number �� -rj —� `�� <br /> MailingAddress� �Q "h�� � � <br /> C�2�rVt� <br /> Sprinkler Contra r's Name ' � ' �'L(� , Telephone Number9���,q�(� <br /> Contact Person <br /> Mailing Address ' �l k� � �,C. �, e � �j- �j � <br /> WATER SUPPLY <br /> Lake Well City�_ <br /> BACKFLOW DEVICE <br /> AVB_� PVB <br /> Year of <br /> Make o Manufacture uantit <br /> Sprinklers 2 � <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 /> l. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ -}-�- p <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 35•� <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 a�d correct. • <br /> ` �l��1CL.(�� ��C'ni���l-�. <br /> Applicant ; l.� Date � d <br /> ******�***�* ********************�*�***********�x********�****** *********�*�x**** <br /> Approved 1`�f� Approved with Corrections Denied <br /> ReviewedBy: v►��'� ��� Date �` ��- �1 � <br />_ _ _ _ ._ <br /> . _ _ _ _ _ _ <br /> _ _ _ _ _ _ _ _ <br /> �-�S�P t fi-�-.. nt c a!�1 ��it r (c�..�J l c l-t � <br />