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�� 2 <br /> ` �(��j� �j���J <br /> �D <br /> Please check one: New _� Addition <br /> JOB SITE <br /> � Owner's Name /�p Q �;/2, `7' ��� /�'Sa n/ Telephone Number y��.s; -� i; ; ,' • :='�'��' � <br /> � <br /> Mailing Address ��p �jq�Q ���f �►/o o � l�v i�� L <br /> Sprinkler Contractor's Name (�����/ I�k C��.�k, ..�.��`::. Telephone Number ;�`��, - ��%'�Y; '�' `'�� `'`' <br /> r-- <br /> Contact Person � �-t��r�a' �/.�n�l �. <br /> Mailing Address ! r <br /> ia.�a�s ���N�������� ,_ � � �� ���,��r-�� ���,���� �,�%� � <br /> S <br /> WATER SUPPLY � <br /> Lake �_ Well City <br /> BACKFLOW DEVICE /�/o � �e. <br /> AVB PVB RPZ <br /> Year of <br /> Make Model Manufacture uantit <br /> Sprinklers /� u r,T�� f� �' �'2 <br /> , � �a,,„ ��Fq �) / ��o a .� <br /> "I'O'I'AL <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: ��?�'/�/ Sq. Ft. <br /> Coverage per Sprinkler: f� �, R� (�ra i lP t D Sq. Ft. <br /> No. of Sprinklers: �5 r�G• (� u��e E .D <br /> Total Water Required: �5 GPM <br /> PERMIT FEE CALCULATION <br /> l. Permit Fee $ 35.00 <br /> 2. State Surchar�e. $ .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 <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> Applicant Date <br /> �*************�****************�**************�*************************�**�** <br /> Approved /'r� _ Approved with Corrections Denied <br /> Revie�ced by: � _ <br /> ��� Z'�--� Date �- �D—� <br />