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� ' <br /> Please check one: New � Addition � <br /> JOB SITE (�L9 ����' t�c5 b � '7�-�. ��/�,�- 8�3�� <br /> Owner's Name �cj,����a�-� ��� Telephone Number <br /> Mailing Address �C� /�ti T ��t.�c� � � 1.t._���,�o,..� .�53`l ( <br /> Sprinkler Contrac r's Name ,�,,;��j,,K,�,�,� z���elephone Number ?2,— /'3�(0 <br /> Contact Person ( � v�� �.C� <br /> Mailing Address f�C� �x �3 �p(�,o��a r �� �S 33� <br /> WATER SUPPLY ' <br /> Lake � Well City <br /> BACKFLOW DEVICE <br /> AVB PVB RPZ <br /> Year of <br /> Make Model Manufacture uanti <br /> �rinklers �� - ��2 i'4o yD <br /> - j�u�,.� �3H-� /s�� 30 <br /> TOTAL �v <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 /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e. $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> Applicant � <br /> � � Date g' g��l� <br /> **�**************************�***x�**�x�******�****��*�**********�*******��*�**� <br /> Approved Approved with Corrections Denied <br /> Reviewed by: � <br /> Date <br />