Yes No

Frame Masonry and Concrete Masonry Steel Exterior Masonry Wall and Frame Combination Type 1A- Concrete Type 1B- Concrete Type 2A- Steel Type 2B- Steel Type 2C- Steel Type 3A- Masonry/Wood Type 3B- Masonry/Wood Type 4- Heavy Timber Type 5A- Wood Type 5B- Wood N/A

Electric Gas Geothermal Liquified Natural Gas (LNG) Liquified Petroleum Gas (LPG) Oil Wood None N/A

Forced Air Hot Water/Radiator Radiant Steam None N/A

Wind Geothermal Solar N/A None

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Asphalt Shingles

Description of Use

Steel Bat Joist

# of Roof Skylights

Exit Lights

Multiple Grids

Back-Up Power Source

Asphalt Tar

Slate

Building Information

# of Exits

CO Date

Fire Detection System

# of Stories Below Grade

Metal

Rubber

Pre-1977 Construction?

Heat Fuel Source

Truss

Roof Russ Type

Roof Coverings

Emergency Generator Powered Devices

Heat Type

Battery

Tile

Truss Construction (Floor/Roof/Both)

Solar Panels

Grade Height

Metal

Wood

Concrete

# of Stories

Construction Type

Metal

Alternate Power Source

Floor Construction

Wood

Maximum Occupancy

# of Roof Hatches

Roof Characterisitcs

Emergency Lights

Emergency Generator

Bowstring

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MT NE NV NH NJ NM NY NC ND OH OK OR MD MA MI MN MS MO PA RI SC SD TN TX UT VT VA WA WV WI WY

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MT NE NV NH NJ NM NY NC ND OH OK OR MD MA MI MN MS MO PA RI SC SD TN TX UT VT VA WA WV WI WY

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MT NE NV NH NJ NM NY NC ND OH OK OR MD MA MI MN MS MO PA RI SC SD TN TX UT VT VA WA WV WI WY

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MT NE NV NH NJ NM NY NC ND OH OK OR MD MA MI MN MS MO PA RI SC SD TN TX UT VT VA WA WV WI WY

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MT NE NV NH NJ NM NY NC ND OH OK OR MD MA MI MN MS MO PA RI SC SD TN TX UT VT VA WA WV WI WY

Address 2

Building Owner

Name

City

City

Email

Business Owner Details

Address

Federal ID #

Phone #

Address

Address

ZIP

Business Description

Phone #

Phone #

Emergency Contact 3

Business Name

Federal ID #

City

Name

Phone #

Email

State

State

Email

State

State

Email

Name

Address 2

State

Name

ZIP

Emergency Contact 2

ZIP

Address 2

Name

ZIP

Address 2

Emergency Contact 1

ZIP

Email

Address

City

Phone #

City

Address 2

Address

Signature

I hereby acknowledge that I have read this application. That the information given is correct, that I am the owner or duly authorized to act on the owner’s behalf, and as such hereby agree to comply with the applicable requirements of the uniform fire safety code as well as any specific conditions imposed by the Fire Official.

Please attach any supporting documents (if applicable).

Certification

Attachments