HomeMy WebLinkAboutF2021-0092 - Permit ApplicationWorksheet for Fire Permit Application
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Please print 3 copies 1 � 0nFppN*
Associated Building Permit # �2� "Z� �(} Fire Sprinkler ri Fire Alarm F Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name �/���� #Units �^
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2. Description of Work
City
Se"QleS
Use
— _-.4014e
Architect/Designer's E-mail Address
Extg Sq Ft j New/Added Sq Ft F-1 Total Sq Ft
Valuation $ L4 S (aa
New F.7 Add F- Alter F_ Demo
# Stories F7
Check Appropriate Box for Applicant/Notification
F7 3. Owner's Name
Last IFirst
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Owner's Address
Owner's E-mail Address
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City
StatezipZip r�--� TelephoneF�� v
F_ 4. Architect/Designer's Name Lasti First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
-.' State r !, Zip F Telephone
) ,' 5. Engineer's Name
Last r---- First �_--- ' Lic. No,
Engineer's Address
Engineer's E-mail Address
City
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State Zip F-- Telephonee�
['6. Contractor's Name Last
First �] /�� Lic. No. �jr�~
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Contractor's Address
Contractor's E-mail Address
City! '�i'...�IH�LICI'�..-.
/�State r_. Zip lJ'[J/
� gZ.��iTelephone�'l�1c9 -/01 %� fl
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OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. U c7 Z ZD 1L
OCCUPANCY - GROUP
PLAN CHECK FEE $