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r <br /> Please check one: New Addition Limited Energy Technology <br /> Systems License# <br /> JOB SITE C 6 f�C? S;Ue\ r . <br /> Owner's Name W U SAn C S(':>.o\,i Cn rN Telephone Number <br /> Mailing Address <br /> Sprinkler Contractor's Name Telephone Number <br /> ContactPerson <br /> MailingAddress_ L�{�1 rt f0n tA612eE <br /> WATER SUPPL �T <br /> Lake Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quanti <br /> Sprinklers O C) 0 <br /> iaro <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: 36 <br /> Total Water Required: S C)pjM pr GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge $ .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 do <br /> all work in strict accordance with the ordinance of the City and State regulations,and certifies that <br /> all statements made on this applic ti e c plete,true and correct. <br /> Applican Date 0 -3 - 29 - 003 <br /> Approved Approved with Corrections Denied <br /> Reviewed By: G)-VNR�, Date <br />