Laserfiche WebLink
, . �- - <br /> . <br /> �lease check one: New�_ Addition <br /> : JOB srrE i�gs L�.�A L 4 k� B/.�a! __ - <br /> _ <br /> Owner's Name �u,��- -b- �3� �r�.. ��c�r,��y Telephone Number 9�5'2��/7�-�}� <br /> � Ma�ing Address � �/�8"S -L°�,a �. �e ,r4/��/ �YB»a M�l �S'S��'G . <br /> Sprinkler Contracto�'s Name�s� z'��;Q��.o,,,Stid,c� Telephone Number�(�/5s/-o Z z 8 <br /> Contact Person �;/fe L,Q,,,,��j <br /> Mailin�Address S��� .l�Br�! ��r.r� .t°u� L�R LG�c, �1,U SS3�"� ' <br /> �yATER Si,�PPLY � <br /> Lake_� Well _ City <br /> � <br /> BACKFI�QtiV DEVICE �/�j�. - <br />� AVg`� P VB <br /> � Year of <br /> ake �Iodel Manufacture uanti <br /> Sprinklers ,c�,-,,�r pG � 2�,�,� /7 <br /> 'T�ra S`r!D-� " 2 oa� �� <br /> �� . TOTAL_,SO <br /> HYDRAULIC CALCULATIONS Design Data: � <br /> Area of Application: _5', �7v Sq. Ft. <br /> Covera�e per Sprinkler: R�,.,� _�o� — .S-T��,� /S' Sq. Ft. <br /> No. of Sprinklers: 5-p <br /> Total Water Required: �_ /� Gp� <br /> PER11�lIT F'EE CALCULATION <br /> 1. Permit Fee $ 3 5.00 <br /> 2. State Surcharge � .50 <br /> 3. Mail-In Fee _ � � <br /> 4. TOTAL PER�tiIIT FEE (Add lines 1-3 above) $ - 35• SG <br /> The undersi�ned hereby applies to the City for issuance of a Sprinkler System Pemut, agrees to do <br /> all�vork 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 �/2-t�/ <br /> ********************************************************************************* <br /> Approved ,M Approved with Corrections Denie� <br /> Reviewed by. - <br /> �.ocv: � Date � l y -6 � . _ ___ : __ _ <br />