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.� <br /> • , —� , <br /> , ` � �`� <br /> Please check one: New � Addition <br /> � ---� - �^� / r�, --� <br /> JOB SITE i � �' `/ /'� ��f;� !„�� ��. �"'�!�c-C� <br /> Owner's Name ,'�����,;��� ,� �• �;� �� ,�,��.�r <br /> � r � ;� ,", , , r : Telephone Number <br /> � , � , ,, <br /> Mailing Address l�7C.' �� fZ��� �l� ��-,,�- �� `''`�` �� ' <br /> Sprinkler Contractor's Name !;'��� �f T-r,r i v����i o� Telephone Number �% '� y� -� <br /> _ `1� <Z Cl <br /> Contact Person ) -��t �_�" � .�� �� ��� �� " � -_ <br /> Mailing Address ���.�-� ���- ��'�� ���5 <br /> WATER SUPPLY � <br /> Lake Well � City <br /> BACKFLOW DEVICE <br /> AVB PVB � RPZ <br /> Year of <br /> Make Model Manufacture Quantitv <br /> S Arinklers %�=��' '� �- i�; ,� � �� <br /> � �i/��.��� c_ '� ' ��i , <br /> �r�.. <br /> HYDRAiTLIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: C� -� <br /> Total Water Required: `% GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharae. $ .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 /> ; <br /> " — �� ��� :�� ��� ' <br /> Applicant '��-1 - �!�` � ` Date �-� � <br /> �**�**x�***�****�*��*�*��****�***����***��**��*****�****��*�*****x�**�***��**��* <br /> Approved Approved with Conections Denied <br /> Reviewed � <br /> ` � --`"- Date �� `' <br />