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, , C�'-�.,�.�-��� <br /> � �,<..a.� az.�� - <br /> Please check one: New J� Addition <br /> JOB STTE �� � 3 /��7FG,S�i7f � . <br /> Owner'sName "7eG�� T /�PS TelephoneNumber�/�� �G7%• �'��.� <br /> Mailing Address 5!a��?�C �1S' G�-f��7�✓G <br /> Sprinkler Contractor's Name �r ��' /)- �f C// �i�G TelephoneNumber I(�� y/�- 3�a j <br /> Contact Person �f�,� /t�E�UNy� <br /> Mailing Address�/:� //k�[�,If7'�' / � h'rC�t /�'l�-PLE��i�j,J J'!7„�� j,5.3,7� • <br /> `yATER SUPPLY <br /> La.ke Well City� <br /> BACKFLO`V DEVICE <br /> AVB PVB <br /> Year of <br /> Make Model Manufacture uanti <br /> Sprinklers �-t,;r�-L� — � ^ <br /> � n <br /> _ �) ..�> -,� <br /> _ �-1�:�L-� i -�- _ r � , � "_; f � <br /> I <br /> - - TOTAL �.'""� <br /> r <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: �.5�.���,� -��;e:.��� Sq. Ft. <br /> Coverage per Sprinkler: _ 4{�>;�;,��!�� Sq. Ft. <br /> No. of Sprinklers: �"^ <br /> Total Water Required: � ;�� Gp� <br /> PERMIT FEE CALCULATION <br /> 1. Permit Fee $ 35.00 <br /> 2. State Surchar�e $ .50 <br /> 3. Mail-In Fee $ �..5�. <br /> 4. TOTAL PERI�IIT FEE (Add lines 1-3 above) $� -�� <br /> The undersi;ned hereby applies to the City for issuance of a Sprinkler System Pernut, 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 /> r, <br /> �' 1 <br /> A licant 1��-h' `� � <br /> PP _L"\, � ► (�=t' �� �`� Date �'/�d.� <br /> ******************************************************************�************** <br /> Approved � Approved with Corrections Denied <br /> Revie}ued by: r�� e�-I�-C? -, <br /> �/Y`��.� 1 2�.,� Date -5 <br /> � (��� �o� :�S �: t- e-. wlc� -�=n=S1,c� <br /> � <br />