HomeMy WebLinkAboutF2022-0181 - Permit ApplicationWorksheet for Fire Permit Application
City of Ne ac uilmg D' ision
Please print 3 copies
Associated Building Permit # nZ� Z (_ �y [7 Fire Sprinkler 'Fire Alarm ❑ Fire Misc
1. Project Address t mailing address) Floor Suite No
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4-uq Cir' 1r RIur a I—II
Tenant Name ofri n # Unit
2. Description of Work
Use
State Zip Telephoned
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Architect/Designer's Address
Valuation $�i ` 2A, ?�
Extg Sq Ft New/Added Sci Ft Total Sq Ft i3�
❑ New ❑ Add Alter ❑ Demo
# Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name
Last First
Owner's Address
Owner's E-mail Address
City
State Zip Telephoned
❑ 4. Architect/Designer's Name Last first 1777-71 Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip F7_7 Telephoned
❑ 5. Engineer's Name
Last First Lic. No.
Engineer's Address
. Engineer's E-mail Address-
City
State Zip 1� Telephoned
❑ 6. Contractor's Name Last First =011
" Lic. No. Class uo
th
Contractor's Address
Contractor's E-mail Address
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City 1761
State Zip Telephone I (Dcv
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
o PLAN CHECK NO.
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OCCUPANCY - GROUP�����
PLAN $