Laserfiche WebLink
Please check one: New Addition Limited Energy Technology <br /> Systems License # <br /> JOB SITE G 6— rc)o <br /> �J <br /> Owner's Name /7,'c -r- ( I,.vVVI rQ S vl Telephone Number 6,1 z 7 u -5-yyk <br /> Mailing Address <br /> Sprinkler Contractor's Name Telephone Number °7�3 vZ�SCo- 37gv <br /> Contact Person ':(`d h, o��L /,',✓5 IC <br /> Mailing Address 6�Z /� �.Y s�(� �` • /�� S/�-,arc C�. , z /7�./� <br /> T— <br /> WATER SUPPLY <br /> Lake Well_ City <br /> BACKFLOW DEVICE <br /> AVB PVB _ <br /> Year of <br /> Make Model Manufacture Quantit <br /> Sprinklers ����1�T r G^ ," O S / 0 <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: '3 G Sq. Ft. <br /> Coverage per Sprinkler: _3 y Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: Z GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surcharge $ .50 <br /> 3. Mail-In Fee $ -fig <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 ordinances of the City and State regulations, and certifies that <br /> all statements made on this application are complete, true and correct. <br /> Applicant Date <br /> Approved Approved with Corrections Denied <br /> ,J <br /> Date <br /> Reviewed By: ( - � o S— <br />