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/ =..0 `-7'/ <br /> Please check one: New I. 1 Addition - <br /> JOB SITE i L9 0 0 Ot.-D GRatsTNi L 13 Al Q <br /> Owner's Nam StaLM*JA Telephone Number <br /> Mailing Address 54 M, It <br /> Sprinkler Contractor's Name A,u4 xu(,, 4,` e , Telephone Number fee/./I 5 6 <br /> Contact Person ...PN 40 iLsere t,/(' <br /> Mailing Address G St, I G,11'y W},jT ?atom...JAI <br /> WATER SUPPLY • <br /> Lake Well )( City <br /> BACKFLOW DEVICE <br /> AVB PVB X RPZ <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers 0 CA 44 s J 57e? f3 / L <br /> , , Pea P. f3 S <br /> TOTAL ) G <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: 44 Ot.) d Sq. Ft. <br /> Coverage per Sprinkler: 44' <br /> �S Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required: / 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 /> Date Q g( <br /> Applicant �6'•••-� 14-egA-...-J. S �� O 7 <br /> ************ ** ************************************************************** <br /> Approved Approved with Corrections Denied <br /> Reviewed by•' / Q. <br /> Jam/s , _G� Date S`'/��/ <br />