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; � �.�,�.__ ( <br /> � - � � <br /> , <br /> Please check one: New � Addition <br /> JOB srrE 1� � � L� .�� t-�� �;�-� ����T �, �� � �� s`r � <br /> � <br /> Owner's Name /e-��`. ._j„�„G ��J TelephoneNurriber <br /> Mailing Address _ /� �0 �y rit,r✓�, f4 �l Q- -���.�� ( <br /> Sprinkler Contractor's Name ���.�,�1�, bT��S,S�, TelephoneNumber �� 3• �S i- 7�7� � <br /> Contact Person _ -� p� �M�,S�P-�� <br /> Mailin�Address- � `� � '7� �3 �:� � tJk ��lJ c��-�, ��L� ct,�c���1�'-� �-f � S�"�(J� . <br /> `VATER SUPPLY <br /> Lake Well � City <br /> BACKFLO`V DEVICE - <br /> � AVB P VB�_ <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers �.'�tStr�. ���-� o� ! �l'7 <br /> i ���( .�.1� ; � � <br /> J� �'Y��i h �vl �C L' ( 2 �Cl`.i <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Covera�e per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Tota1 Water Required: � � Gp� <br /> PER.i1�IIT FEE CALCULATION <br /> 1. Permit Fee $ 3 5.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERitiIIT FEE (Add lines 1-3 above) $ <br /> The undersi;ned hereby applies to the City for issuance of a Sprinkler System Pernut, agrees to do <br /> all�vork in strict accordance �vith 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 � <br /> /�-�� �; <br /> ******�*****�**********************�*�**�**************************************** <br /> Approved Aporoved with Corrections Denied <br /> Reviewed by: � � . <br /> �� <br /> �'����, �;�-f�-�-��-�1,�;�_��.;�-�__ Date j�1 -�j �-�-' � <br /> , ����__"l'.� � ,�tl,� t (''�:��a`�L Y`, (j ^ �� � fi`' - ( l� ''s��,�`'. '�t f7 !'r, <br />