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ANEXO J
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Requerimento
Consulta Tcnica
PSPCI N_____________
Complemento:
Municpio:
Bairro:
CEP:
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E-mail:
Telefone:
E-mail:
3. IDENTIFICAO DO RESPONSVEL TCNICO PELO PPCI (Obrigatrio somente para PSPCI de risco mdio)
Nome:
CPF:
Telefone:
Formao profissional:
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N CREA/CAU:
Pg: _____________________
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Propietrio e/ou
Proprietrio
e/ou responsvel
responsvel pelo
pelo uso
uso da
da edificao
edificao
ResponsvelTcnico
tcnico pelo PPCI
Responsvel
PSPCI
Pg: _____________________
ANEXO J
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______________, RS, ____ de ______________ de ________
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NOME
POSTO
NOME DO
DO OFICIAL
OFICIAL ENCARREGADO
ENCARREGADO Posto
FUNO
Funo