HomeMy WebLinkAboutAPPLICATION - 07-00101 - A-1 Fire Protection Services6-0
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REXBURG
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A,merira's Fayntly Community
L°SAFE'Z'X SYSTEM
CERTIFICATION PERMIT"
APPLICATION
_BUILDING SAFETY DEPARTMENT
19 E. Mair
Rexburg, Idaho 83440
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HERMIT#:
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$I00 Fee Paid: Ye
Phone: 208-359-3020 x
Fax 208-359-3024
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No PetmitApproved: Yes/
No
B Y.w Date!*
safe�i gstem
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BUSINESS NAM
FSI ADDRESS:
OFFICE PHONE N t ""
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CONTACT PERSONS
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CELL PH ONIE
PLEASE IDENTIFX SYSTEMS TO BE COVERED BY THIS P113IT- C ECK ALL TI -IAT
APPLY.
_FIRE ALARM SYSTEMS - Alaxm (:onttactors shall have a minimum of NICET Level 1
Certifications.
.#*PLFASE PROVIDE CERTIFICATIONS:
:'NICET Ce�rification
****Panel Certficafion ^x--
*"'Proof of l iability Insurance
AUTOMATIC SPRINKLER SYSTEMS *FieSprinkles Coni actors shall have a minimum of
NICE -T Level III Certifications.
❖PLF.ASE PROVIDE CERTIFIC;ATTONS�
•:*NICET Cettification
****Any Additional Certifications
•:'P1:00f of Ii -ability Insurance
./]FIRE EXTINGUISHERS_STANDPIPE SYSTEMS `SMOKE CONTROL SYSTEMS
_SPECIAL HAzARD SYSTEMS FIRE PUMPS
AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING
***P7.SrISEPROVIDEDOGUAIENTATIONOFTIZAItdINGLBVEL� INSTALIgTIONCERTIFICATIONS,
LIABILITYINSURANCE, ETC. FORAI.Z. DISIPLINES***
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BUSINESS N"ffi:
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
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caNrPArvY NAMR:
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N
COMPWY NAME: PHONE #:
**%r -'**PLEASE LIST ADDITIONAL C,OMPANY AUTI-10RIZATIOTNS ON THE BACK OF THIS FORM**,**
I -"rlifY that I have read this p cui n and dedare linder . en2LI
ty Of PL'Tj11TY that the inforrnat4
Comply With allcity Ordinances 10n Contained hercin 'IS correct and complete. I agree to
life siifety systems. I hereby authorize r r s c ti- 5 Of this cit3r to ' and mam'tenance and t st
ancc the work, or I represent the owner as signified above and arn Actmg 'Xith the ovrneA Purposes. I am cither die contra -tor ycsponsi-bl'C t-��r
/cGntracto[�� -Ad
PRINT NAGE OF APPLICANT
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APPLICANTTl u W
DAT ,. _-
PE RMITVALID UNTIL
Y 2007
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