Laserfiche WebLink
M ' <br /> Please check one: New � Addition <br /> JOB SITE (450 ©(dor 0 <br /> Owner's Name \4ur & f r Telephone Number <br /> Mailing Address 4-157) ©P©0O 2 <br /> ppp ,,r1 Cis, <br /> Sprinkler Contractor's Name prv�esSsiicJ SA- - Telephone Number eon--a z)-53-2-Q <br /> Contact Person 9.48- totc. <br /> Mailing Address 1 Sz/7 )e ' 9. ) A) <br /> WATER SUPPLY <br /> Lake Well x City <br /> BACKFLOW DEVICE n <br /> AVE PVB c1 ;� Cori,-a-C _ Wov,c12 ,k <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers <br /> TOTAL <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) $ <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 complete, true and correct. <br /> Applicant Date 9-01 <br /> ********************************************************************************* <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> Date <br />