Laserfiche WebLink
. � ��69 <br /> Please check one: New � Addition � <br /> JOB SITE 3t-15� (�dlZ�1-� ��0�2� �.�.,�/� <br /> Owner's Name ��7 L �M,q�,( Telephone Number y 7( — C�Sg <br /> Mailing Address S"o�rv�� '` Gt�3�r?��� Ni�J 5S 3 a ( <br /> Sprinkler Contractor's Name�`��,L,�,�S v�tn/�Il �,22�`��ephone Number q 3�{� 523� <br /> Contact Person �'-(-P� W'���.�s <br /> Mailing Address ��d �- � (/,' <br /> /�! , �P, _��� <br /> WATER SUPPLY ' <br /> Lake Well � City <br /> BACKFLOW DEVICE <br /> AVB PVB � RPZ <br /> Year of <br /> Mak Model Manufacture uanti <br /> S rinklers <br /> . . �� <br /> TOTAL <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 <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 <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 /> Applicant Date ! ''2 "�9� <br /> ****�******�* *******�*�***�***�****�*****x�************���******�x**********�** <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> Date <br />