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Please check one: New Addition <br /> JOB SITE /38S— OfOrt,0 CS✓� <br /> Owner's Name SQoo y\Q-Z ,5 Telephone Number `-#4-`26/._3 <br /> Mailing Address YWL () <br /> Sprinkler Contractor's Name 'Yrc '— S�W\ Q(&_ Telephone Number `-72.- -/7/ <br /> Contact Person e- <br /> Mailing Address t 5`{)5-- S*, l._,J u '`-,-''� /" ' — S 3gE <br /> WATER SUPPLY <br /> Lake Well City <br /> BACKFLOW DEVICE <br /> AVB _ PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers S-20o (-0 <br /> -to Q-o 5')O J7 <br /> TOTAL S(;) <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: 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) $ .35,E <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees to <br /> do all work in strict accordance with the ordinances of the City and State regulations, and certifies <br /> that all statements made on this ap s lication are complete, true and correct. <br /> Applicantlqi/ , ./ . Date `7-�8-9-7 <br /> q` <br /> Approved Approved with Correc(ions Denied <br /> Reviewed by: / / <br /> ��Q� , Date Tia`-97 <br />