Laserfiche WebLink
Please check one: New Addition <br /> JOB SITE /Cc c � -,.,v •a- / -� <br /> Owner's Name ,f cLz.11- -� Telephone Number <br /> Mailing Address <br /> Sprinkler Contractor's Name Z/&ez 4r1 o,✓ /l,6m• ; Telephone Number(6 ez, ' 72-y70 <br /> Contact Person <br /> Mailing Address (( , Cj S141,7 7 � P S n`i /I'1 A / M iv . s-c 3e,s-- <br /> WATER SUPPLY �/ <br /> Lake Well / -- City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make • Model Manufacture Quantity <br /> Sprinklers —24/n) - 131 Rv F/4-4-Co n) ,�a7z 2 f2. <br /> TOTAL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: 5006 fi — 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) $ <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 thi ap.lication are complete, true and correct. <br /> p <br /> Applicant � Date 9",Z -1 7 <br /> ********** ********************************************************************* <br /> Approved Approved with Corrections Denied <br /> Reviewed by: .�:G�Cc./ <br /> Date q- 2-cp7 <br />