HomeMy WebLinkAboutAPPLICATION - 19-00168 - 1082 E Moody Rd, Sugar City 83448 - Firewise LLC - Annual Fire Safety CertificationoQ aaUri
.a CITY OF Building Safety Department
u' y° RMUR xCity of Rexburg
Submit By Email
CW 35 North 1st East
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Rexburg, Idaho 83440
For Office Use
Permit Number:
$100 Fee Paid: ❑ Yes ❑ No
1. Property Owner
Business Name: /
Office Address:
Office Phone:
Safety System Certification Permit Application
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Permit approved: ❑ Yes ❑ No
ersonerson:
: State�.d Zip
Cell Phone:
2. Project Description
Please identify systems to be covered by this permit
Check all that apply:
❑ Fire Alarm Systems -Alarm Contractors shall have minimum NICET Level 1 Certification or equivalent
*The Following Certifications are Required: oNICET Certification oPanel Certification oProof of Liability Insurance.
El Automatic Sprinkler Systems - Fire Sprinkler Contractors shall have minimum NICET Level III Certification or equivalent
*The Following Certifications are Required: oNICET Certification oAnyAdditional Certifications oProof of Liability Insuran
❑Automatic Extinguishing Systems for Commercial Cooking • Proof of training for commercial cooking heads Required
Fire Extinguishers • Proof of Certification and Training RequireLJy UN AL
❑Standpipe Systems ❑ Fire Pumps ❑ Special Hazard Systems ❑ Smoke Control Svstems
3. Represented Companies
Please list all companies that your business is authorized to represent
Company Name:
Company Name:
Company Name:
Company Name:
Company Name:
Company Name:
Phone Number:
Phone Number:
Phone Number:
Phone Number:
Phone Number:
Phone Number:
***PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, INSTALLATION CERTIFICATIONS, LIABILITY
INSURANCE, ETC. FOR ALL DISCIPLINES***
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein
is correct and 1 swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the Cityof Rexburg
shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012
International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): �� /�/2� Signature- �i`/
Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician -208
( ) 372.2341 Revised March, 2016