HomeMy WebLinkAboutSLC Fire Safety Permit ApplicationFah 14 01 10:54a SLCFD FPB , (561.) 462-2323 p. 1
'9'vkP of Regues_t:
ST. LUCIE COUNTY FIRE DISTRICT
FIRE SAFETY PERMIT APPLICATION
2400 Rhode Island Avenue
Fort Pierce, Florida 34950
Telephone (561) 462-2312
Fax: (SG l) 462-2323
( )Plan Review ( ) Site plan ( ) Fire Alarm System
{ j Fire Sprinkler System ( ) Fixed Fire Protection System
Niue] Storag[Dispensars ( ) LP Gas Storage/Dispenser
( ) Fireworks Display/Sale ( ) TenVs ( ) P-_rmit Renewal
j Other
Project Location:
Owner Information:
Name: _L3-\-L- K2 , L-
flildress:
SZ�'C�vJ�ST (�{JS SoUC`S S czE
Contractor Information:
Company Name: Qsz-
Qualifier. L't_2.ELL-- Z��.t nl s
State License 4 C- C QD S \2)
County/City License #
Address:.. `�-\`Zl �-A �1L ' ����.�rJ �-� a.N , ��r� .')3 Lk
Telephone: -----
See Reverse
Feb 14 01 10:54a SLCFD FPD '
(561) 462-2323 p.2
Valuation of Work: �._� ZSc, pia
Contractor Affidavit: Application is hereby made to obtain a permit to do the work and
installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit.
In consideration of granting of this requested permit, I do hereby agree that I will, in all respects,
perform the work and installation in accordance with the approved plans, the applicable N.F.P.A
Cosies, the Standard Building Code, the State Fire,. Marshal. Rules, and Local Fire Codes. Plan
revisions after the.issuance, of the.permit .is subject tc-, approval by the authority having
jurisdiction.
Contractor Signature: a444� Date: Z
Office Use Only
( )Approved ( ) Rejected Signature: Date:
Comments:
Permit #
Permit Fee: