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2. 
4. Request Type

   1. Request for modification of code (CBC 104.10, CFC 104.9)
   2. Request for alternate material, design or method of construction (CBC 104.11, CFC 104.10)
6. To apply for this request, complete sections 1, 2, & 3 (ink or type)
8. 1. Site Address
9. APN
10. Date
12. Owner
14. Address
16. Email
17. Phone Number
19. Applicant
21. Address
23. Email
24. Phone Number
26. Permit Number
27. Dept/Div
28. Job Status
30. Type
31. Stories
32. Occupancy
34. Floor Area
35. Occ. Load
36. Use of Bldg
40. 2. REQUEST

    For code modifications, please state the applicable code requirement and the extent of relief desired. For alternate, requests, state the type of system proposed and design methods. Submit plans if necessary to illustrate request. Additional sheets or data may be attached.

44. 3. JUSTIFICATION/FINDINGS OF EQUIVALENCY

    For code modifications, applicant shall demonstrate that special, individual reasons exist that make compliance with the strict letter of the code impractical and that equivalency is provided. For alternate requests, applicant shall demonstrate quality strength, effectiveness, fire resistance, durability, and safety that is equivalent to the code for a similar use.

46. Code Section(s):
47. Petitioner's Signature
49. Date
50. Position
52. Reviewed by:
53. Date:
57. The Request is:

    1. GRANTED
    2. DENIED
58. Dept Comments:
60. Conditions of Approval:
62. Building Official
63. Print
64. Date
66. Fire Marshal
67. Print
68. Date
72. No. of Items
73. Fee Due
74. Date Paid
76. Receipt No
77. Processed By
79. DEPARTMENT ACTION: After determination, copies to 1.) applicant, 2.) permit file.
Leave This Blank:


80. 1. Receive an email copy of this form.
81. Email address

    This field is not part of the form submission.

82. Submit

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