HomeMy WebLinkAboutAPPLICATIONS - 08-00283 - Phoenix Fire Protection LLC - Fire Safety Certificationof REXBL7,k • •
�� r CITY OF
" o RE 1�� wJ11. BUILDING SAFETY DEPARTMENT
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r H , America's Family Commu nity 19 E. Main St. Phone: 208 - 359 -3020 x326
Rexburg, Idaho 83440 Fax: 208 - 359 -3024
www.rexbura.oro janellh @rexburg.org
"SAFETY SYSTEM PERMIT #:
CERTIFICATION PERMIT" $100 Fee Paid: Yes /No Permit Approve /No
APPLICATION
BY• �� Date:L1 e
"A safety system certification permit is required to install, mod ,maintain, or service all neiv and existing
fire extinguishers, fire suppression ystems, fire alarm systems, and other life safety systems avithin the City of
Rexburg"
BUSINESS NAM h � r ] �,,,�
(�enix 1 l� ��T(� - IIonk eh
OFFICE ADDRESS: e) 8 O N - 39l� S+.
OFFICE PHONE NUMBER: l ZOO 4to O 9115
CONTACT PERSOM YL�'- �1 C� CELL PHONE #: (Z.9) 4O ( ^ Z !� �
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECK ALL THAT
APPLY.
FIRE ALARM SYSTEMS - Alarm Contractors shall have a minimum of NICET Level 1
Certifications or equivalent.
❖PLEASE PROVIDE CERTIFICATIONS:
❖NICET Certification
❖Panel Certification
❖Proof of Liability Insurance
V AUTOMATIC SPRINKLER SYSTEMS * Fire Sprinkler Contractors shall have a minim of
NICET Level III Certifications or equivalent.
❖PLEASE PROVIDE CERTIFICATIONS:
❖NICET Certification
❖Any Additional Certifications
❖Proof of Liability Insurance
FIRE EXTINGUISHERS u - S TANDPIPE SYSTEMS SMOKE CONTROL SYSTEMS
SPECIAL HAZARD SYSTEMS IRE PUMPS
AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING
** *PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, INSTALLATION CERTIFICATIONS,
LL9BILITYINSURANCE, ETC. FOR ALL DISIPLINES * **
• •
BUSINESS NAME: -►' I lIJ tYI l y
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANY NAME:
COMPANY NAME:
COMPANY NAME:
PHONE #:
PHONE #:
PHONE #:
**** *PLEASE LIST ADDITIONAL COMPANY AUTHORIZATIONS ON THE BACK OF THIS FORM'*
I certify that I have read this application and declare under penalty of perjury that the information contained herein is correct and complete. I agree to
comply with all city ordinances, adopted codes, and state laws relating to the installation, modification, service, and maintenance of new and existing
life safety systems. I hereby authorize representatives of this city to inspect any work for compliance p oses. I am either the contractor responsible for
the work, or I represent the owner as signified above and am acting with the owner's /contra cto knowledge or consent.
I ran 4 - 1�'► Ge_.
PRINT NAM OF APP ICANT APPLICANT'S SIGNATURE
t p �� l o�
DATE PERMIT VALID UNTIL DECEMBER 31, 200$
0
Phoenix Fire Protection LLC
1388 North 39th Street
Nampa ID 83687
PERMIT# 08 00283
• 2008
C I T Y OF
REXBURG
CV10 SIGNATURE
America's Family Community
■ AM ®