Laserfiche WebLink
...�35. sa <br /> . <br /> � p�o�.3g8 <br /> Please check one: New � Addition <br /> JOB SITE <br /> Owner's Name_���(1n � �\�jG�Q TelephoneNumber <br /> Mailing Address L)�J�'� �'j�(�0`�c� 1 Gt Yl.� <br /> Sprinkler Contractor's Name U � Telephone Number �L/���3�j <br /> Contact Person�R, C2 ��v` aS.e K <br /> Mailing Address�S� � C i�`/1Mz'S f' �c�r K Li/� � ' <br /> `VATER SUPPLY <br /> Lake Well City <br /> BACKFLOW DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers � ,�G3 <br /> --'aa� s�o Gl� � �l <br /> TOTAL <br /> HYDRAULIC CALCITLATIONS Design Data: <br /> Area of Application: �� rl o0o Sq. Ft. <br /> Coverage per Sprinkler: qbo c,-i- /o a Sq. Ft. �'� py � '` <br /> No. of Sprinklers: �/2, �-3� ,�� �--�d's <br /> Total Water Required:/r-r+X �o�� /S S GPM <br /> PERiI�IIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ 1.50 <br /> 4. TOTAL PERNIIT 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 � ' Z L-� • � v <br /> ********************************************************************************* <br /> „ <br /> Approved Approved with Corrections Denied <br /> Reviewed by: <br /> ��� Date y" 2 7 i��% <br />