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� . � <br /> ���,� 'ij��. <br /> � J <br /> � <br /> ,/ i /����� <br /> Please check one: New /'� Addition ;� �'�a � �Z�� <br /> JOB SITE � �� � , Y �,<� :- � , -`='{ r^2 T �. - < ` I �_- v' j� <br /> , � <br /> Owner's Name !�<''r - ��� �, r'� �,�'�,,v-� / ,����/� Telephone Number <br /> Mailing Address <br /> Sprinkler Contractor's Name i'.`' ` ��;�, ; � � ' �� �;_ Telephone Number ��;i� �� >-�� <br /> Contact Person ,--�� i�'� ' �=- ������ <br /> Mailing Address �/ � - .- - ' ' '� ✓ <br /> � -��- j � � � i � <br /> WATER SUPPLY <br /> Lake Well - City <br /> BACKFLOW DEVICE �� � ���,,r�.r,�� �at�� <br /> AVB P� �Z <br /> Year of <br /> Make Model Manufacture Quantitv — <br /> S rinklers <br /> <;; ' �� ,. <br /> TOrTAL <br /> HYDRAiTLIC 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 $ 35.00 <br /> 1, Permit Fee $ .50 <br /> 2. State Surchar�e. $ 1.50 <br /> 3. Mail-In Fee $ <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 /> � �_ /' Date ,, <br /> Applicant - . _ - K_ , _ <br /> *x�**********************************************�***�***********x�*******��**** <br /> A roved � Approved with Corrections Denied <br /> PP <br /> Reviewed by. <br /> ` ��_� s`�'�'J�"' Date �"3��'�� <br /> ����' <br /> 5 <br />