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��1� -�=�� <br /> � Please check one: New � Addition . <br /> JOB SITE �,��f� ��C� (f G���e� �.� <br /> Owner's \Tame � ��,���- � �o� Telephone Number -�SZj� <br /> Mailing Address �� �U �(�c/ct;r✓� �n <br /> Sprinkler Contractor's Name � �n e:S� �'���� r,�_ Telephone Number G��/ - 0��2.. <br /> ContactPerson i�d^ � G � � <br /> � <br /> Mailing Address �c.�� I � � r' � , l � N t • ,�c.� G �U <br /> WATER SUPPLY <br /> Lake �_ Well City <br /> BACKFLOW DEVICE - <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uanti <br /> S�rinklers �uv� -�e,- ��c:� v.��-��. <br /> TOTAL O <br /> HYDRAULIC CALCULATION� Design Data: <br /> Area of Application: SC�U c� Sq. Ft. <br /> Coverage per Sprinkler: _ rj � Sq. Ft. . <br /> No. of Sprinklers: <br /> Total Water Required: /� GPM <br /> �ERi1�IIT 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 to <br /> do all work in strict accordance with the ordinances of the City and State regulations, and certifies <br /> that all statements made on this a plication are complete, true and correct. <br /> , <br /> Applicant /� �� <br /> Date C� ��_ <br /> �a��x�x�x�*�k���x�a��� ���k�k�k��k��*�=kXx��k�x�k�x�x*xx��kX�k��a�a��xx���*M���x�����x��xx� <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> .,.�� , � ���_ Qf <br /> Date (� <br />