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ANEXO I

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Ao Sr. Comandante do Corpo de Bombeiros Militar

Encaminho a V.S., formulrio para

Requerimento

Consulta Tcnica

PPCI N_______________

FORMULRIO DE ATENDIMENTO E CONSULTA TCNICA FACT

1. IDENTIFICAO DA EDIFICAO OU REA DE RISCO DE INCNDIO
Razo Social:
Nome Fantasia:
CNPJ:
Logradouro:
N:

Complemento:

Municpio:

Bairro:
CEP:

2. IDENTIFICAO DO PROPRIETRIO OU RESPONSVEL PELO USO DA EDIFICAO (mediante procurao)

Nome do Proprietrio:
CPF:

Telefone:

E-mail:

Telefone:

E-mail:

Nome do responsvel pelo uso:

CPF:

3. IDENTIFICAO DO RESPONSVEL TCNICO PELO PPCI

Nome:
CPF:

Telefone:

Formao profissional:

E-mail:
N CREA/CAU:

4. DOCUMENTOS JUNTADOS O FACT

Comprovante de pagamento de taxa de servio no emergencial

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ANEXO I

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5. OBJETO DO REQUERIMENTO OU CONSULTA TCNICA E FUNDAMENTAO LEGAL

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______________, RS, ____ de ______________ de ________

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Propietrio e/ou
responsvel
pelopelo
uso da
edificao
Proprietrio
e/ou
responsvel
uso
da edificao

ResponsvelTcnico
tcnico pelo
Responsvel
peloPPCI
PPCI

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ANEXO I

Rubricas:
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6. DESPACHO (para preenchimento do CBMRS)

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______________, RS, ____ de ______________ de ________
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NOME
OFICIALENCARREGADO
ENCARREGADO Posto
POSTO
NOME
DODO
OFICIAL
FUNO
Funo