HomeMy WebLinkAboutF2022-0503 - Permit ApplicationWorksheet for Fire Permit Application eF
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Please print 3 copies
�1 -� Q� j Fire Sprinkler ❑Fire Alarm ❑Fire Misc
Associated Building Permit #
Floor
Suite No
1. Project Address (Not mailing address)
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#Units
Tenant Name N 0 6) Z_e I � G
2. Description of Work I Use I A3 - g
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Valuation $
Extg Sq Ft � New/Added Sq Ft �� Total Sq Ft
# Stories F7
❑ New ❑ Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
❑ 3.Owner's Name Last First
Owner's Address
City StateI
Last First
❑ 4. Architect/Designer's Name
Architect/Designer's Address
CityI— I State
Owner's E-mail Address
Zip � Telephoned
Lic. No.
Architect/Designer's E-mail Address
Zip Telephoned
❑ 5. Engineer's Name
Last First Lic. No.
Engineer's Address
I
City State
[]6. Contractor's Name Last I ti iDlle
Contractor's Address
g531 Milliken, Av�,
City ; cN70 CVCcir�'l'r1rl�IGr State
OFFICE USE ONLY
TYPE OF CONSTRUCTION
Engineer's E-mail Address
�I
Zip Telephone
First F777771, Lic. No. Class 1C71707
Contractor's E-mail Address
W(VI or- hSL1Y1S S IVIS ��t
Zip Telephoned
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEE $
OCCUPANCY - GROUP