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` (oO?Z <br /> Please check one: New X Addition (/0 0 0 <br /> JOB Sin; f''o o DSO c s 7,01.. 701a <br /> Arco <br /> 1 <br /> Telephone hone Number <br /> Owner's Name P <br /> cry-�-1. � �� �•r�� <br /> Mailing Address CrPrxt E <br /> Sprinkler Contractor's Name Agiott4 FO,d, 4 Telephone Number 4v/-/Is 8 <br /> Contact Person L.r4*fir/4 <br /> Mailing Address 6 ce., i Cly-7 W P c 40424(c.4) <br /> WATER SUPPLY • <br /> Lake Well X City <br /> BACKFLOW DEVICE <br /> AVB PVB 7't RPZ <br /> Year of <br /> 'Make Model Manufacture Qua>�ty <br /> Sprinklers ? 7 i k re. A fe - (.• <br /> TOTAL 6 3 <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: 5 `Ii o' '3 Sq. Ft. <br /> Coverage per Sprinkler: f Cl 0 Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: 1 0 GPM <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ .$ 35.000 <br /> 2. State Surcharge. $ 1.50 <br /> 3. Mail-In Fee <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 .G•+I.-A• Date 7 ../8- frY <br /> *********.**************.*****.....************.*********.***.*******.*.****** <br /> Approved X. Approved with Corrections Denied <br /> Reviewed by: <br /> I 9 <br /> 44. e. / _/,G.�/�/i Date /� <br />