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4/M"C-- <br /> Please check one: New Addition <br /> JOB SITE /74,7 /1 TA 1F-- <br /> Owner's Name 7 04- tofW Rtrd I/, X60101 Telephone Number <br /> Mailing Address kr Oko tiJ o oT C/J A rd X d, <br /> Sprinkler Contractor's Name / '(f' S �'�r�L(tr Telephone Number ('/,;/_ W--(34-54? %�A"sfrs <br /> fo <br /> Contact Person Z/`ic c c� Co e7 e (C <br /> Mailing Address /o 3 akd /4 LQ, ,c 54 A k.d'Ic e (1") <br /> WATER SUPPLY <br /> Lake Well ✓ City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture Quantity <br /> Sprinklers //'e.(s o ,4 o -co o O /P77 <br /> 5' ' cef7 /x'99 4-412 <br /> TOTAL /13 <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: S 6' 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 i `' Date 7— 17 <br /> ********************************************************************************* <br /> Approved Q< Approved with Corrections Denied <br /> Reviewed by: 01(4•^••-- <br /> Date 1. 2$ • 91 <br />