Application for FIRE SYSTEM PERMIT
BUILDING SERVICES DIVISION
1700 Civic Drive DuPont, WA 98327
P: (253) 912-5217 F: (253) 964-1455
www.dupontwa.gov
Permit Number:______________________
Application for □ Fire Suppression □ Alarm System □ Standpipe System □ UG Fire Service Mains □ Fixed Suppression
__Auto __Manual __NFPA96 __NFPA 17
Type of Bldg: □ SFR □ Duplex □ Multi Family/No.Units _______ □ Commercial: Type _____________ New__ T/I___
(i.e. Day Care, Business, Food Service, etc)
Scope of work: □ New Installation □ Repair Existing System □ Alter Existing System __Add __Remove __Relocate
Description of Work:_________________________________________________________________________
Project Address: Parcel Number:
Owner of Building: Phone Number:
Mailing Address (if different from Project Address):
Applicant (if contractor, fill out next section): Phone Number:
Address:
Contact Person: Phone Number:
SCHEDULE OF FEES
(OFFICE USE)
Valuation $_______________________
Permit Fee $__________
Plan Review Fee $__________
(due @ submittal)
SUBTOTAL $_________________
Deposit (if any) $__________
Receipt #: __________
TOTAL $_________________
I certify that I am the: □ Owner □ Contractor □ Agent
I hereby certify that I have read and examined this application and state
that the above information is correct. I agree to comply with all City
Ordinances and State Laws, whether specified herein or not.
***By leaving the contractor information section blank, I hereby certify
further that contractors (General or Subcontractors) will not be hired to
perform any work in association with this permit.
Signature Owner / Authorized Agent Date
Valuation of Work: Project Sq. Footage (required):
Type of System: □ 13 □ 13D □ 13R □ NFPA 14 □ NFPA 20 □ NFPA 24 □ NFPA 13 □ NFPA 72
□ NFPA 96 □ NFPA 17 □ Smoke Removal System □ Flammable & Combustible Liquid
Type of Sprinkler: □ Deluge □ Dry □ Preaction □ Underground □ Wet □ Chemical
Type of Pipe: _________ Commodity Class:_________ Storage Height:_________ Head Type: __________
Contractor: Phone Number:
Address:
State Contractor Number: City Business License:
Project Contact Person: Phone Number:
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