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rt Beach Fire Permit Application 44:
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Number and Street suite/unit zip
Associated Building Permit #
2 Owner / Tenant
Name
Scope of work/
3 mist. description
New TI Addition Alteration Demolition
Construction
Check one
�//�� Number of Stories per
Commercial Fir 5 rinkler L L7 Number of FS Heads building
13 3R 13D
nMulti-Family(3+units) n Fire Alarm nNumber of FA Devices Number of Dwelling
Units
nResidential (1-2 units) n Fire Underground 1 1 1 Number of Risers
-Check one El Fire Misc. *Write in accurate count
'describe above 11
4 Applicant Information Name
Address: j�{ 172� iEoralT S�• U ,J�v G'�l g26S�
Phone#: Email: dz(,`',rZoroit%�t iEx�Laj • G
®Check if same as Contractor
Designer Information Name:
Address:
Phone#: Email:
Check if same as Contractor
Contractor Information Name:
Address:
Phone#: Email:
License#: S8LtU Class: G16
-
IA \
Office Use Permit Plan Check Permit/Plan
Number `� Number. �h Check Pee $