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{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
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Non-Life Hazard Use Application
Address 2
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Address 2
Emergency Contact 2
Building Owner
State
Name
Zip
Email
Business Owner Details
Federal ID #
State
Phone #
Address
ZIP
ZIP
Email
State
Address
State
Email
Phone #
City
Phone #
Business Name
Address 2
Federal ID #
Name
Phone #
Email
Address 2
Address 2
Name
Local ID
City
ZIP
Name
Address 2
Address
Business Description
City
Zip
Emergency Contact 3
Name
Emergency Contact 1
Business Phone Number
Email
City
Business Email
Phone #
State
Address
Address
City
Alarm/Suppression System Description
Sprinkler System
Monitoring Company Name
Details
Roof Construction
Building Information
Other Hazards
Square Feet (of business space)
Type of Construction
Truss Construction (Floor/Roof/Both)
Flammable/Combustible Liquids
Closest Fire Hydrant
OS+Y Location
Floor Construction
Knox Box Location
Monitoring Company Phone #
Amount Due
Business SQ.Ft
Code Sections
Fee
Up to 999 square feet
§ 157-8A
$75
1,000 to 4,999 square feet
§ 157-8A
$150
5,000 to 9,999
§ 157-8A
$225
10,000 to 14,999 square feet
§ 157-8A
$300
15,000 to 19,999 square feet
§ 157-8A
$375
20,000 feet and up
§ 157-8A
450
Application Fees
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Type Full Name :
Sign With Hand
Clear
Done
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
Your application has been submitted successfully.
Business Owner Email:
Date Submitted:
Reference #
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