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ANEXO I

Ao Sr. Comandante do Corpo de Bombeiros Militar do Rio Grande do Sul

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 OU REA DE RISCO DE

INCNDIO
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 (para preenchimento do CBMRS)

Comprovante de pagamento de taxa de servio no emergencial

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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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Proprietrio e/ou responsvel pelo uso da edificao ou rea de risco de incndio

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Ressponsvel tcnico pelo PPCI

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6. DESPACHO (para preenchimento do CBMRS)

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NOME DO OFICIAL ENCARREGADO Posto
Funo