Laserfiche WebLink
Please check one: New J`, Addition • <br /> JOB SITE 27 0 sod Cj/ � � Rots: <br /> Owner's Name Telephone Number 1 g_ Oa 2 co <br /> Mailing Address 9 0 A•0 CPI S?r 4 r fi`-'l P <br /> Sprinkler Contractor's Name q�� L,, , Telephone Number 'cf/-//3 t <br /> Contact Person `\ /• <br /> Mailing Address 511411 �-, l,J q,.s�-„ ��►-Q r�,,v-•� <br /> WATER SUPPLY <br /> Lake Well )( City <br /> BACKFLOW DEVICE <br /> AVB PVB y RPZ <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers w..x 41?. PGP <br /> "1 n +R- 3"? v T a RV 1 1 <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: 5/ OG O Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: S 0 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 <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 - -a-� 1.4„ad.—.-----CDate ciej <br /> Approved LYN Approved with Corrections Denied <br /> Reviewed • • <br /> A2r, ) Jt/!L Date /4>// j <br />