HomeMy WebLinkAboutF2021-0227 - Permit ApplicationMPnntForrt" Worksheet for Fire Permit Application �EW�Rm
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Associated Building Permit # [— Fire Sprinkler r Fire Alarm [ Fire Misc
1. Project Address (Not mailing address) q Fll0000rr Suite No
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Tenant Name �ot:'" C g #Units r ---
2. Description of Work
FP�Mob V toretry Cjdl2 VOua 6 S Z
Extg Sq Ft 7 4 New/Added Sq Ft �,>a.— Total Sq Ft G�l. f Valuation $
F_ New r AddAlter r Demo # Stories
Check A 11-A—SP�Z
ppropriate Box for Applicant/Notification
F 3. Owner's Name Last
_. _. First r. --__---_--
Owners Address Owner's E-mail Address
City .._._ ,..... State -Zip F_ Telephone[-_—_
[ 4. Archi ec signer's a Last First
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Ar,c/hite esi ner'sddress Archite Designe' -mail Address
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city \ �2e 2
t` State Zip �� Telephone �� �f��! Zf J zi
F_' 5. Engineer's Name Last
Engineer's Address
City State
First ILic. No.
Engineers E-mail Address
Zip Telephone_..—_. _..
[. Contractor's Name Last T tNo. Lic.
Class[ ej O
Contractor's Address Contractor's E-mail Address
City �' 11 ��,.� t' GNB n �/
\ t— State 1 �=T Zip ct Telephone
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
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PERMIT NO. _-�_Z0_Zj 0 7�7
PLAN CHECK NO. 1" 00 ZZ_1'"t_
PLAN CHECK FEE $