Laserfiche WebLink
. <br /> � � ��o9-d6s3� <br /> ' Please check one: New Addition <br /> JOB SITE D{�v o � <br /> Owner's Name '�,,,-� ��,,�_e,/ Telephone Number a,.sa�'�7a �'��� <br /> Mailing Address_ J�(o C� lvo►�-�h �_���Y Orvnc�,rn n� <br /> Sprinkler Contractor's Name �rc,2�Son —c,a,si,/c/j .�,c TelephoneNumber �7�,3`y7�1-3/a/ <br /> Contact Person�,�,� // oa�, � (p��-j�,�-7Sf��� Cz/c.� <br /> Mailing Address � ( I �� it.�,�:.�1�f �P ���.iy� „rr'!�'U .�S �-r1 • <br /> �VATER SUPPLY <br /> La.ke Well � City <br /> BACKFLO`V D VICE <br /> A� �VB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers v��e✓ 9� ✓ :�oc,�� 3U <br /> - TOTAL 3b <br /> r <br /> HYDRAULIC CALCITLATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: ,30` S Ft. <br /> No. of Sprinklers: 3� <br /> q• <br /> Total Water Required: IS� GPv1 <br /> PERiI�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 PERIVIIT FEE (Add lines 1-3 above) $ � ,�� <br /> The undersi�ned 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 /> Applicant Date � <br /> *************** *********************************�******************************* <br /> Approved Approved with Corrections V Denied <br /> Reviewed by: ��� i�1� <br /> t,,d, Date_ �- � � � � <br />