HomeMy WebLinkAboutF2019-0042 - Permit ApplicationWorksheet for Fire Permit Application OI72 �Od9 `W"�
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Associated Building Permit# K Fire Sprinkler [_ Fire Alarm i—Fire Misc
t. Project Address (Not mailing address) Floor Suite No
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t e t/AOiv DI LAob #units 1-33
2. Description of Work
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Extg Sq Ft % Z,Tj, New/Added Sq Ft '.. Total Sq Ft 7fj fj
Valuation $ I' 15i 00 0
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r New F_ Add Alter#
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Check Appropriate Box for Applicant/Notification
(Y\3. Owner's Name Last First
Owner's Address Owner's E-mail Address
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City �� G�1_.. State Zip �{.Q�QO_. Telephone 6" 3100'
(�4.Architect/Designer'sName Last mlllUV4 First V"I V Lic. No./�a3(J�(/
Architect/Designer's Address Architect/Designer's E-mail Address o
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City �w__. _. States Zip "I vU� Telephone fi- Zai 0141 C..
17>5. Engineer's Name Last f l y� First U Lic No. 2a3
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Engineer's Address Engineer's E-mail Address o
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City ®'i rVv State �— Zip�tf j Telephone 'fiq 2?23 DLII ._._..
6. Contractor's Name Last P/�GM(IUr� First ! U I Y I Lic. No. Class
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Contractor's Address Contractor's E-mail Address `I 0 y[Q . ggr4nK-Ler G q I
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OFFICE USE ONLY PERMIT NO.ZOI
TYPE OF CONSTRUCTION PLAN CHECK NO. Z i
OCCUPANCY - GROUP n -003 GN PLAN CHECK FEE $
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