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41 " <br /> Please check one: New X Addition <br /> JOB SITE _ ' .,. C1, .-772-. <br /> ►;r ,' —Iv- <br /> aril. <br /> Owner's Name (- -} 1 a--C Vii, 047cj Telephone Number 4/2 —7,?,5--7 <br /> Mailing Address A O , �o�C &.' 6 d'1.y S's/a_ ( b c ,S-S-3 --? <br /> Sprinkler <br /> S rinkler Contractor's Name <br /> PO3- JL �5 2 Telephone Number S3 7- 7517 <br /> Contact Person r/t 4c K o 1=/6 v,= .e t -'g)r1,v k / - 1 , <br /> Mailing Address 2// p 6 V Qva v ,Z /2& <br /> WATER SUPPLY <br /> Lake _ Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers 7--/D )- ci v 5 -c /IA p o, 10 E,C, <br /> TOTAL • <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: S6 ii6ce -- Sq. Ft. <br /> Coverage per Sprinkler: /gyp ' ,D/A_ Sq. Ft. <br /> No. of Sprinklers: /SSo <br /> Total Water Required: 36-6 P /-* 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 <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 application are complete, true and correct. <br /> Applicant .Y.;---co: Date a l7 <br /> Approved Approved with Corrections Denied <br /> Reviewed by: / <br /> / ✓`>� <br /> Date 97 <br />