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. 2o�Z - od � zZ <br /> ` _ CC�i�`�" ��Z 9 /�'2_. <br /> Please check one: New� Addition Limited Energy Technology <br /> Systems License # � L V n�3,5� <br /> JOB SITE �O I" l ��"-���� <br /> � <br /> Owner'sName �� �� �� TelephoneNumber Z - � �7� <br /> Mailin Address ` n, <br /> g � � � 1 1��0 IC,� � �`i, 7�`�j� <br /> Sprinkler Contractor's Name � � Telephone N er W�Z` °(�-� � �� I� <br /> Contact Person � L - �_ <br /> Mailing Address - 6 6 C ��S � ��'U.�� I--� � ��-� <br /> WATER SUPPLY <br /> Lake Well�_ City <br /> BACKFLOW DEVICE <br /> AVB PVB�_ <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers �{-�L7.��'� P�P Zv�'� , <br /> TOTAL ��� <br /> HYDRAULIC CALCULATIONS Design Data: <br /> � <br /> Area of Application: � ��`-' S Ft. <br /> q• <br /> Coverage per Sprinkler: 3c�Ffi�'pi��)� Sq. Ft. <br /> No. of Sprinklers: Z$ <br /> Total Water Required: 3 ' S Z�� _ . GPM <br /> � � ���� <br /> PERMIT FEE CALCULATION � <br /> 1. Permit Fee $ 5.00 J�� ' � <br /> 2. State Surchar�e $ 5 5 . <br /> 3. Mail-In Fee $ <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � -�r'. � � <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 /> � <br /> Applicant ���� D�e S�N� � Z� � � <br /> ***************** *******************************************�****************** <br /> A roved � <br /> pp Approved wrth Corrections D�� <br /> Reviewed By: �/ �� � � Date "v� � , � <br /> � <br />