HomeMy WebLinkAboutF2016-0473 - Permit ApplicationWorksheet for Fire Permit Application
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Associated Building Permit # F r, Fire Sprinkler UV..: Fire Alarm F-; Fire Misc
1. Project Address (Not mailing address) Floor Suite No
59
! # Units
Tenant Name
2. of Work
State Zip[ Telephone
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Architect/Designers Address
Architect/Designers E-mail Address
City
Valuation $
Extg Sq Ft New/Added Sq Ft F Total Sq Ft F
Firstr Lic No, F
-Add
# Stories
New F r Alter [-Demo
Check Appropriate Box for Applicant/Notification ( /
3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City _-.
State Zip[ Telephone
F_ 4. ArchitecUDesigner's Name Last
First F Lic. No. F
Architect/Designers Address
Architect/Designers E-mail Address
City
State F. Zip Telephoner
(- 5. Engineer's Name Last
Firstr Lic No, F
Engineer's Address
Engineer's E-mail Address
i
City
State Zipr— Telephone
F 6. Contractor's Name Last r
First 376ve Lic No F1778(0 Class 42-(,'O
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Contractors Address
ontractor's E-mail Address
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State Zip % Telephone ��.0 - _ JL_' 2-. 022 C
OFFICE USE ONLY
PERMIT NO. 1/0 01
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TYPE OF CONSTRUCTION
HECNOV
�}) PLAN CHECK NO'
V
OCCUPANCY- GROUP
0 PLAN CHECK FEE $
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