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iatiVialt. PJ, '5 <br /> LVA g cf-/-07 <br /> $355D <br /> Please check one: New X Addition Limited Energy Technology <br /> Systems License# PLO 26g7 <br /> JOB SITE LEC h(Di,,3 'jam ) ,bEN CE <br /> Owner's Name t€ Sc h 00 Telephone Number&1Z— 12 6'1Z-co <br /> Mailing Address 12OO J)CI Cif t�S-}ck\ g Ay r6 . <br /> Sprinkler Contractor's Name t 12, Zf X CrIlephone Numbers C1 S Z qc-i 6)S).(A <br /> Contact Person ljy vi coo ' C 'n N <br /> Mailing Address P9 R ox 40 ST, eon.\-E-15C los yYY <br /> WATER SUPPLY <br /> Lake(P71•)1:) <br /> t X Well City <br /> BAC W DEVICE FAG FI `b2 J. C t ( Q <br /> AVB PVB hSo. OJ POA a TO W€ 1 I SL) $f-erz1 <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers j Ma& <br /> )c>io ,Sgo/D Zoo 6 )O3 <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: 6000 `'YaS Sq. Ft. <br /> Coverage per Sprinkler: ),o Sq. Ft. <br /> No. of Sprinklers: )D3 <br /> Total Water Required: -300\ 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) $ 3 .7. CO <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 co ' .lete, true and correct. <br /> Applic. i ��i Date o c-0 — 0 7 <br /> *********************************************************** ********************* <br /> Approved Approved with Corrections (/ Denied <br /> Reviewed By: Date —07 <br />