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.-,. . _ <br /> . r__� <br /> Please check one: �New _ Addition - <br /> JOB SITS ��v ,�/ S�d�'� !�i . <br /> Owner's Name �I Qo'��S �r��✓� Telephone Number �yG -�� �� <br /> �` / i <br /> Mailing Address <br /> Sprinkler Contractor's NamerGt� I��G� Telephone Number /� T S� <br /> Contact Person �s-r'-�� �-e �G� , <br /> Mailing Address �70U ��vH OS�� �-r /�/ `,�rr��.��/h ��G� !'�� 5���`�S� <br /> #��*:***:*�**:�::**:*:**:**�**: *::**:**�******** **�*:: **:�*:**�,��*::*��� <br /> C7�ASSIFICATION OF OCCQPANCIBS <br /> Commercial Residential '� <br /> �:t#*�*:�*:**�*:**:*::**#*t******t******:�r�**:**:**�:***t**t****:***�**�:** <br /> WATER SIIPPLY <br /> Lake Well City <br /> :****��*t*****:*****:*****:::*::*:**t:**�*t**t��***:�**********::*:*�*::�** <br /> Year of Orifice <br /> Make Mode 1 Manufacture Size Quantity <br /> �rinklers • �o a•O <br /> r� . o,p � � ..J� <br /> ,. �7oc 3� ,� �,�. �'fs <br /> TOTAL GI!',a <br /> *******�***#**�**:**t********************t**�*�*t*#�*****#***:�******�:**** <br /> HYDRAIILIC�CALCIILATIONS Design Data: �� ��� �```� <br /> Ar`ea of Application: Sq. Ft. ��P� ����`� �� <br /> Coverage per Sprinkler: Sq. Ft.�"�"„"�"" o � �' <br /> No. of Sprinklers: 3�.-�ti{� rtd �..M��..•.�� <br /> Total Water Required: ,�/. GPM. r''rG� �� ���., ��� �v..,.� . <br /> ******:**#:*****************:**:****�************:** *�� * *�** * ** *** <br /> PERMIT F$S CAI,COLATION <br /> 1. Permit Fee $ 30. 00 <br /> 2. State Surcharge. Based on valuation. $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERIKIT FS$ add lines 1-3 above $ <br /> The undersigned hereby applies to the City of issuance of a Sprinkler <br /> System Permit, agrees 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 app lication are complete, true and correct. <br /> Applicant �� (/���%�!�"` Date � '��/-7�/ <br /> ************************************* ************************************ <br /> Approved Approved with Corrections Denied <br /> Reviewed y <br /> _ l� <br /> Dat <br /> / I <br /> ✓� � _ <br />