|
t
<br /> k�
<br /> � t� i
<br /> Please check one: New Addition )C
<br /> JOB SITE �3� YG'� ,�,�'`CJ r �,���F � �U��,i i,�'�.
<br /> Owner's Name [� �� ��; � �y��',�,f Telephone Number �( ]�-- p �"�,� �
<br /> �
<br /> Mailing Address 30�'p'6 �'°C� �������. �1��`�`'� C^ t�'r�-'�`` �/►�J,(,•'�
<br /> Sprinkler Contractor's Name L�`!:� �k�a J=�f'' �.� ,,��',,�"'�`,,,.1�Telephone Number,.�',`�,;�'a�` %"���
<br /> Contact Person �r''J,,�'�►��,��� �'/,�� s
<br /> Mailing Address ` `. " ' ,�x '' � ,f' ` `" "` ;r�;_,�
<br /> ,
<br /> �, , . ..� . <
<br /> .
<br /> �'' ` ' "�{ � � �
<br /> , .,. , �'t � ��, �: �
<br /> ;`,� ��_.f � z a..�� 4'l�'.,. £�d .r �G. � �+,. 4._7 :.J
<br /> WATER SUPPLY
<br /> Lake F�Vl�1 Well City
<br /> s- A.
<br /> BACKFLOW DEVICE
<br /> AVB PVB PI��f��a�._.
<br /> Year of
<br /> Make Model Manufacture Ouantit�
<br /> Snrinklers �r?�'D '�G� �:. ��."�-�l�Y� '`7 �'
<br /> '��-Y` a:.� rw'�' r'�`} `�'1�, ,�G
<br /> TOTAL c'�
<br /> HYDRAULIC CALCULATIONS Design Data:
<br /> Area of Application: ��� ±�• a � ��.d �%"c:`�� Sq. Ft.
<br /> Coverage per Sprinkler. �;�v4���� ��>e� � ����:�/� � 3noc� Sq. Ft. �,.
<br /> No. of Sprinklers: � � f�
<br /> Total Water Required: � �' �'��. ,-��., ���h3, �J�-�r' :r�,�'�� GPM
<br /> u�•c� z,� N� `> T'o ��,f tv ?o C_'��-Ftr� s..
<br /> PERMIT FEE CALCULATION � '. °:: ` ...�e^ <;,,�' ti`f
<br /> 1. Permit Fee $ 35.00
<br /> 2. State Surchar�e. $ .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 /> do all work in strict accordance with the ordinances of the City and State regulations, and certifies
<br /> that all statements made on this application are complete, true and correct.
<br /> A licant �� �� �� Date _ 7'_� ,��
<br /> rr �
<br /> �k�k�k�k�k�k*�k�k�kx���k�k�k�k�k�k�k�k*�k�k�k�k�k�k�k�k�k�k�kx�k�k�k�k���k�k��k�k�k�k�k�k�k�k��k�k�k�k�k�k�k�k�k�k�k�k�k**a�**��k�k�k��k�k�k�k
<br /> Approved \ Approved with Corrections Denied
<br /> Reviewe y•
<br /> �"—�-' Date / �j��
<br />
|