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. • �/C�- �� - � � <br /> Please check one: New Addition <br /> Jos SITE Z� � �i �L.Pctis�.� -�- 2� brm-�v <br /> Owrier' s Name � /wt �r ��A'f� �� '�^-� �"�� Telephone Number `"Y?/- 9U/�J <br /> Mailing Address Z� 5 4 t� ��'�S�_ � 1�.� 1`�cc-P�s�o � l�.�- S�3 3/ <br /> ,� +1v i r usti w���r.�1 <br /> Sprinkler Contractor' s Name �,�;,�,d-�r,r+�n c Telephone Number �i�Z - �3��� <br /> Contact Person �J�1� .�� ����c o,� _ <br /> Mailing Address �o 'r3ox S��3 ��c,A�ev r /Li� ss33/ <br /> ***:****��*****�**********************************�***�****************�*** <br /> CLASSIFICATION OF OCCIIPANCIBS <br /> Commercial Residential �_ <br /> **t*********�**�*******�***t*****t****t****t******t*�***�*:**�*********�**t <br /> WATER SIIPPLY <br /> Lake � Well City <br /> **�********�*****************�****************************�**�*******�*�*:* <br /> Year of Orifice <br /> Make Model Manufacture Size uantit <br /> Sprin ers / ��� r� TZsv rf `7 3 � D � z- — <br /> /A'O�/ C Z- '' S - 3�� <br /> TOTAL Z <br /> *t�*******�*��*************�*t*�***t********t�**�***t*****�******�******�** <br /> HYDRAIILIC CALCULATIONS Design Data: <br /> Area of Application: Sq. Ft. <br /> Coverage per Sprinkler: (.PD Sq. Ft. <br /> No. of Sprinklers: (s 2- �r S��� <br /> Total Water Required: IZ - �'� GPM. P ` � <br /> ****�******�*�****�**�***�*******t********�t**�**��*�**�**�*�t�************ <br /> PERMIT FEE CALCIILATION <br /> 1. Permit Fee $ 30 . 00 <br /> 2 . State Surcharge. Based on valuation. $ .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 of issuance of a Sprinkler <br /> System Permit, agrees to do all work in strict accordance with the <br /> ordinances of the City and State regulations, and certifies that all <br /> statements made on this application are complete, true and correct. <br /> e a <br /> A licant l � � � Date y�ls-�Z <br /> ******************PP******************************************************* <br /> Approved -� Approved with Corrections Denied <br /> Reviewe by: <br /> 1 ���� <br /> Date <br />