Laserfiche WebLink
� <br /> Please check one: New Addition <br /> JOB SIT'E -=� ���f� �,�����.,,� c`_� <br /> Owner'sName ��'��� .�"�'�'s��� TelephoneNumber ���>�-����� <br /> � Mailing Address �>ov ����J���C L� � � <br /> Sprinkler Contractor's Name ,� ��� Telephone Number <br /> Contact Person <br /> Mailing Address � <br /> `VATER SUPPLY <br /> Lake Well City X <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers `�"`� �z_� <br /> TOTAL <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 to do <br /> all work in strict accor c�-�ith the ordinances of the City and State regulations, and certifies that <br /> all statements made this application are complete, true and correct. <br /> � �i�� _ — � <br /> Applicant •� � � ��'�c,�� - �� � Date y,/���5 <br /> ******************************************************�************************** <br /> Approved �/ Approved with Corrections Denied <br /> Reviewed by: `� ` <br /> �� � �^�-i � Date ��,,Li'7��'� <br /> .,���-�-,. <br />