Important: Applicant to complete all non-shaded areas and mark or circle where applicable.
Do not write here
Customer’s
Information
Important: Applicant must fill ALL four (4) sections “A, B, C, and D” of this application.
Failure to do so may result in rejection and/or delay of the reviewing process.
Job Address
Number and street suite/unit Floor Phone at site if available
Permit Number
F
Name (Company) Contact Person Number and Street
Contractor
State Zip State License Number
HartsvilleLicense Number
Phone
Relevant Building Permit.
B
Check applicable
permit holder box
Legal Owner
Name Address Phone
Total Fees
Tenant Name
(
If applicable)
Name Number and Street Phone
Estimated Cost
Building Type
Residential Commercial All Other
Job Description
Type of Work New Replacement Alteration All Other
Gross Floor Area
Classification Of Work
Fire Suppression Systems Gas / Halogenated Systems Fire Alarm System
Quantity Description Y N FM 200 Quantity Description
________ Sprinkler Heads Y N Inergen ( N, Ar, CO2 ) _________ Initiation Devices
________ Stand Pipe Risers Y N _________ Signaling Devices
________ Total No. of Fire Hose Valves Y N
Carbon Dioxide (CO2)
Other _________________________
_________ Panel Review
________ Hood Suppression System _________ Specify the number of Systems _________ Panel Re-Review
________ Fire Pump _________ Fire Main _________
Extender / Amplifier
Description of Other work not mentioned above
_________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________
Certification
I hereby certify that I have the authority to make the foregoing application, that the application is correct, and that the construction will
conform to the regulations in the current
adopted South Carolina Building
Code and the City Of Hartsville codes.
Signature of Applicant Address Name (print) Date Phone
NOTE: This permit shall become invalid if the authorized work is not started within six (6) months from the date issued, and/or if the authorized work is suspended for a
period of six (6) months after the time for commencing the work. If no work has begun, the permit may be returned within six (6
) months with a request for cancellation.
Hartsville Fire Department
111 South Seventh Street, Hartsville, SC 29550
website: hartsvillesc.gov | Phone: 843-383-3000
FIRE PROTECTION PERMIT APPLICATION
A written letter of authorization from the property owner, if other than the applicant, shall be submitted indicating knowledge of the applicant's intent.
