Annual Permit Application Fire Protection System Contractor Form - Rescue Department

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MOBILE FIRE - - - - RESCUE DEPARTMENT
MOBILE FIRE
RESCUE DEPARTMENT
MOBILE FIRE
MOBILE FIRE
RESCUE DEPARTMENT
RESCUE DEPARTMENT
FIRE CODE ADMINISTRATION
FIRE CODE ADMINISTRATION
FIRE CODE ADMINISTRATION
FIRE CODE ADMINISTRATION
Annual Permit Application
Annual Permit Application
Annual Permit Application
Annual Permit Application
Fire Protection
Fire Protection
Fire Protection
Fire Protection System
System
System Contractor
System
Contractor
Contractor
Contractor
Date: _____ / _____ / ____
Annual Permit Fee: $241.00
Fire Code Official: __________________________________
The Contractor requesting an annual permit must sign and present the required documentation
before the application will be processed.
Business Name: _______________________________________________________________
Business Address: _____________________________________________________________
Contractor Name: _____________________________________________________________
Contact Number: ______________________ E-mail: ________________________________
Check
Business License
State Fire Marshal
Liability Insurance
Fire Alarm
Permit
Business License
State Fire Marshal
Liability Insurance
Sprinkler
Applied
Business License
Training Certificate
Liability Insurance
Hood System
For X
Clean Agent
Business License
Training Certificate
Liability Insurance
Business License
Fire Extinguisher
Training Certificate
Liability Insurance
I submit this application affirming possession of valid certifications; license and insurance, with the
understanding that all work performed shall be in accordance with the provisions of the 2009
International Fire Code with local amendments, also known as the "Fire Code of the City of Mobile." I
understand it is the my (the contractor’s) responsibility to keep all required certifications, licenses and
insurance valid and current and to immediately report to the Fire Code Official situations in which they
are not.
UNDER PENALTY OF INTENTIONAL MISREPRESENTATION AND/OR PERJURY, I declare that I
have made this application and it is true and correct to the best of my knowledge and belief.
Authorized Contractor Representative: _____________________ Date: _____ / _____ / __________
Permit Reviewer: ________________________________________ Date: _____ / _____ /__________
Mobile Fire-Rescue Department / Bureau of Fire Prevention / Fire Code Administration
2851 Old Shell Road Mobile, AL 36607 (251) 208-7484

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