Laserfiche WebLink
, , <br /> Please check one: New � Addition <br /> JOB SITE �`�g� /�v f�� ��--� �. <br /> Owner's Name '�c��,�,.r� �,�� Telephone Number <br /> Mailing Address ��t,w�.-� <br /> Sprinkler Contractor's Name �t�e.s5rv �(�,,�.Y�Telephone Number��2�1`\1`� <br /> Contact Person �� {���-� <br /> Mailing Address f �S [Q��" 5�_ ������ J�v� � S�3�C� <br /> Lake Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Ouantitv <br /> e <br /> �7 `70 <br /> TOTAL `1 <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 /> PF.RMiT FEE CALCULATION <br /> 1 Permit Fee $ 35.00 <br /> 2. State Surcharge. $ .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 /> 1�� do all work in strict accordance with the ordinances of the City and State regulations, and certifies <br /> � that all statements made on this ap lication are complete, true and correct. <br /> Applicant Date �—Z���� <br /> *�����**����x*� ���x*�x��x*�����x�*�����*�***������x*���x��x������*��x�*������x�x�**�*��� <br /> Approved Approved with Corrections Denied <br /> Reviewed <br /> Date �`o�q� <br />