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Please check one: �New �ddition �� ��r� <br /> JOB SITE �Y �/ S � / • r�''�V�� � 2 , V <br /> Owner ' s Name l�,�,�L„�� (�� Telephone Number y 73 " f� '��' �Gf <br /> Mailing Address ��-- . <br /> Sprinkler Contractor' s NamP��ILtQ �-K/t�/GAT/!�N �N�.Telephone Number �3 7- 3Z �/� <br /> Contact Person �0 f3 ��lc�L%/2 <br /> Mailing Address 7 -� Z O Ll�-/�� a Q. �'����'`�S ,C���'� /L/� /� • <br /> *****�***�*****�***�***�*�*********�*************�******** *******�**���**� <br /> CI.ASSIFICATION OF OCCIIPANCIES <br /> Commercial Residential � <br /> *�******************�**���****�*�**���**�*��tt�*********:**�**�*���*�****t* <br /> WATER SIIPPLY <br /> Lake � Well City <br /> ****�**�***** *�*�**�******��***��******�***�*�**�***********���*�*�****t** <br /> Year of Orifice <br /> Make Model Manufacture Size uantit <br /> S rink ers c/ <br /> �V- D Sf-f � <br /> TOTAL <br /> **��*�**�***�****�***�*******�**�****�*��**�#*�t****�***�****�****�**�***�� <br /> HYDRAIILIC CALCIILATIONS Design Data: <br /> Area of Application: ,�.3 ��a Sq. Ft. <br /> Coverage per Sprinkler: 3 Sq. Ft. <br /> No. of Sprinklers: .37 <br /> Total Water Required: /B'c� GPM. <br /> **t�***�*t***�***#***:*��***�*******�********�***��****t***************:**� <br /> PERIriIT FBE CALCIILATION <br /> 1. Permit Fee $ 30.00 <br /> 2. State Surcharge. Based on valuation. $ .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 of issuance of a Sprinkler <br /> System Permit, a�rees to do all work in strict accordance with the <br /> ordinances of the City and State regulations, and certifies that all <br /> statements made on this application are complete, true and correct. <br /> ��/�����- gqt - � � 7 <br /> nLA� (/L.� �1 A' C�+1' I� IA-Wl�i F r�f'�l� � <br /> a f� <br /> Applicant Date -�� ��� <br /> ***************************************** ******************************* <br /> Approved � Approved with Corrections Denied <br /> Review d by: <br /> � ��� �-- ��/�� . <br /> � Date <br />