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. <br /> �/9 7 <br /> � _ <br /> z�?ease check one: �ew Addition <br /> JOB SITE <br /> �wrer' � N�me C . q-,Q i � EC, Telephone Number �{7/- ��6 <br /> �ailing Address ��O �A-6ZT�.�1(,c�ool� �� <br /> ��rinkler Contractor' s Name �o.��Q ���r,���'-��elephone Number ���h'78'/ <br /> Contact Person �FE-�J -��ef+�^� <br /> �Mailing Address � o �ox /1�3 /�R-�� �2nu� �� �'�� / � <br /> ****�:�*t****#**********�#****�:*:*****��*************�**#t�**********��**� <br /> +CI�ASSIFICATION OF OCCQPANCI$S <br /> Commercial Residential � <br /> �*�**�*�**:t******:*�:*�:**��******� ***t*****�***�**t****::*********#***t* <br /> WATER SIIPPLY <br /> Lake � Well City <br /> �*****�****�*** *****�******�*�*****t**********�*****�**f**:********�****** <br /> Year of Orifice <br /> Make Model Manufacture Size Quantit <br /> SDrin ers 7o�eo s�oo � c�n i To 3 CPM� S � <br /> TOTAL <br /> �t�*********��*�*�*s�*�****�***t��*��t��*�*��***********************t*�*****� <br /> HYIaRA�ZIC CAi�CIiLATIONS Design Data: <br /> Area af Application: Sq. Ft. <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: <br /> Total Water Required:__� GPM. �' <br /> ��**�***�***�*****#**********�***t*f*t***�*��****************t***�r�**�e*�*at* <br /> PERMIT FEE CALCIII�ATION -�`� �� <br /> l. Permit Fee $ `3'�"""D'� <br /> 2 . State Surcharge. Based on val�aation. S •�0 <br /> 3. Mai�.-In Fee $ ":"�"� <br /> 4 . TOTAL PEF.�iIT FEE add lines 1-3 above $ <br /> � <br /> �'he undersigned hPreby applies to the City of issuance of a Sprir�k.l�er <br /> System Permit, agrees to do all work in strict accordance with tr�e <br /> �ardina.nces of the City and State regulations, and certifies that all <br /> �tatements made on this application are complete, true and correct. <br /> ��� <br /> Applicant Date 5���"g3 <br /> tir�t�k�k�lr�tilydt�*�r�kytir�k �rykdk�tiketikyk�F�k�ryF�k �k�k�k�k �k*�t�kyFdt�t*itikyk�kytikdk�k�tdkyt�tdr�kdtdt**yt�k�ir�t*�tir�F�k�r�r�k�t <br /> °z�proved Approved with Corrections Denied <br /> pviewed by <br /> �i�l� ����' � � <br /> " Date <br />