HomeMy WebLinkAboutF2019-0468 - Permit Application_Print FormWorksheet for Fire Permit Application
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Associated Building Permit# I F_ Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name*-: Po 1;0 M D?c.✓�L II N #Units
Owner's E-mail Address
2. Description of Work
State F_ Zip TelephoneF_
r 4. Architect/Designer's Name
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Extg Sq Ft r- New/Added Sq Ft F— Total Sq Ft
Valuation $
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# Stories F
F_ New F_ Addter
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State FC -A Zip / z _8z) TelephoneF_
Check Appropriate Box for Applicant/Notification
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F_ 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
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State F_ Zip TelephoneF_
r 4. Architect/Designer's Name
Last I M a r -L First J ig Lic. No. J —
Architect/Designer's Address
Architect/Designees E-mail Address
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City ii;_ -
State FC -A Zip / z _8z) TelephoneF_
F_ 5. Engineer's Name Last
,First [_ Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
State r_ Zip _ Telephone
r 6. Contractor's Name Last C'orpgo FIX �tya� �eN First Lic. No. �r -�.7 jCI FC 1�
Contractor's Address
Contractor's E-mail Address
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City
State F�: Zip I Telephone
OFFICE USE ONLY
j PERMIT NO. ZU
TYPE OF CONSTRUCTION
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OCCUPANCY -GROUP
` q PLAN CHECK FEE $
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