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� S sc=� � i � oC�C� <br /> � <br /> � 4���/�/ <br /> . . - � � 3�/�� <br /> � Please check one: New� Addition Limited Energy Technology <br /> Systems License# <br /> JOB SITE 1�� � ��� �� t��v � <br /> Owner's Name N�,�� �'�-�� Telephone Number q ��"�4'�"g��� <br /> MailingAddress�, �� C� l�ri,°� Lo�,�(e �l�c� c�YCY�� /�'{�� S'S-�S� <br /> Sprinkler Contracto 's Name .�_'.�,--��.�,,� l�'r��_ Telephane Number!Q 1 a �2 i b��(�` <br /> _, <br /> ContactPerson (, �,-5, � <br /> . <br /> Mailing Address� � � �'�' E�w�l �Z� �., ��S'Y"�-uv� �� �3 � � <br /> WATER SUPPLY <br /> Lake Well � City <br /> BACKFLOW DEVICE � <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture ti <br /> Sprinklers <br /> � <br /> (—�Y.� �`, c 2 c� 4.Et,� Z��'"1 -'�\_ <br /> To�rAL �� � <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: �j} �jU� Sq. Ft. <br /> Coverage per Sprinkler: 3£3 Sq. Ft. <br /> No. of Sprinklers: � j <br /> Total Water Required: Z��M 0cr �,e.:.2 � c7 . GPM �t�( �V�. <br /> � <br /> PERMIT FEE CALCULATION ��� �S <br /> l. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTALPERMIT 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 tlus application are complete,true and correct. <br /> Applicant D�be � �� ��'T— <br /> ******************* ****** ***** ****************s**********�#*�**************** <br /> Approved Approved with Corrections Denied <br /> r+��, , �-, <br /> Reviewed By: �(,�� ���(� Date � ' �C7'v� <br /> Reset Form <br />