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_ � 3 �� <br /> � <br /> Please check one: New L'' Addition � <br /> JOB SITE �� 7 �7 � ��-i �r t�r- � <br /> Owner's Name �.5�`"a�, '��: �� ��-��- Telephone Number ��7� //('(`� <br /> Mailing Address _ `j ,t��y, L <br /> Sprinkler Contractor's Name �u �,,; -{-( -- Telephone Number �T�� �� l�`)� <br /> Contact Person �,4 L� � U Y: i r r� Y-� � <br /> Mailing Address ��7� ����� � �r�j.r � �� �S'L=��,� �`1 � �v,�.- .����� 7 <br /> WATER SUPPLY � <br /> Lake 4i' Well Ciry <br /> BACKFLOW DEVICE <br /> AVB PVB RPZ <br /> Year of <br /> Make Model Manufacture uanti <br /> �rinklers c�i���-�2 f�C� � � � ���-� <br /> TOTAL <br /> HYDRALTLIC CALCULATIONS Design Data: <br /> Area of Application: G�� C'C��L� Sq. Ft. <br /> Coverage per Sprinkler: ��j Sq. Ft. ' <br /> No. of Sprinklers: _'� � �, <br /> Total Water Required: /�` GPM�'2�^����. <br /> PERMIT FEE CALCULATION ����J� �� <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 /> ;� <br /> �,_ � .._��� (.i,1 Date <<- 5�- �/t�_ <br /> Applicant � �``�` <br /> ****�***�***�**�*�**�*�***�***x�*��**����*****�***��*������**�*x�*x�****�x��x�*x�**� <br /> Approved . ` Approved with Corrections Denied <br /> Reviewed by: ° ' <br /> � �,} <br /> � �:�<>°'` -' � Date J—�"`�� <br />