Fillable FIRE PERMIT APPLICATION (City of Liberty Lake)

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FIRE PERMIT APPLICATION (City of Liberty Lake)

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The FIRE PERMIT APPLICATION (City of Liberty Lake) form is 2 pages long and contains:

  • 2 signatures
  • 20 check-boxes
  • 38 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Liberty Lake

BROWSE CITY OF LIBERTY LAKE (WA) FORMS

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02/25/2019 Page 1 of 2
Along with this application please provide the following:
o One digital copy of drawings / plans with supporting documents
All businesses which are located in, or perform work in the City must have a current WA State Business License
with a City of Liberty Lake Endorsement.
CHECK ONE BOX BELOW TO INDICATE WHO THE APPLICANT IS
Owner’s Name:
Email: Phone:
Address:
City, State, Zip:
Contractor’s Name:
Email:
Phone:
Address:
City, State, Zip:
WA State Contractor License:
Contractor UBI Number:
Project Contact’s Name:
Email:
Phone:
Site Specific Information
Project Address:
Assessor’s Tax Parcel:
Project Description:
(please describe in detail the scope of work) Estimated Value of Project:
Fire Sprinkler:
System Type:
Underground Fire Supply Fire Suppression # Head Count:
13 13R 13D
Fire Alarm: Control Panel Devices # Count:
Assembly Tent Paint Booth Type 1 Hood
Multi-Family Residential
# of Units:
# of Stories:
Site Zoning:
Required Signature
BY SIGNING BELOW, I ACKNOWLEDGE THAT A MINIMUM OF 24 HRS. NOTICE IS REQUIRED FOR ALL INSPECTION REQUESTS
Applicant's Signature
Printed Name
Date
Permit Issuance Option
Would you like to receive your permit via email? Yes No
(If yes, please complete the following portion. Once review of your application is complete, we will contact you for credit card payment via phone.)
New Commercial / Industrial Tenant Improvement Multi-Family Residential Other:
FIRE PERMIT APPLICATION
Liberty Lake Planning, Engineering & Building Services
22710 E Country Vista Drive, Liberty Lak
e, WA 99019
Phone: (509) 755-6726 Fax: (509) 755-6713
Website: www.libertylakewa.gov
Email: permitcenter@libertylakewa.gov
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02/25/2019 Page 2 of 2
The permit becomes null and void if work or construction authorized by the permit is not commenced within 180 days of
issuance or if construction or work is suspended or abandoned for a period of 180 days at any time after work is
commenced, unless an extension is granted. Issuance of this permit does not give the authority to violate any federal,
state, or local laws or ordinances, or the building code regulating construction. Separate permits (building, plumbing,
mechanical, sewer, water connection, electrical, etc.) may be required for work performed on this site. Additional permits
/plans may be required prior to Certificate of Occupancy issuance. Contact SRCAA at 509-477-4727 and/or visit
www.spokanecleanair.org
to ensure compliance with air quality regulations. The applicant shall be responsible for
obtaining additional permits/approvals from affected agencies. By checking the box below, I certify that I have read and
understand all of the conditions contained herein and I have the authority to sign on behalf of the applicant. Additionally, I
certify that my signature included on the permit, if done by electronic means, provides the same understanding and
authority as if I had signed the permit in person or writing.
BY SIGNING BELOW, I GIVE MY PERMISSION FOR USE OF MY ELECTRONIC SIGNATURE ON THE PERMIT AND I
ACKNOWLEDGE THAT I UNDERSTAND AND AGREE TO THE TERMS DESCRIBED ABOVE.
Applicant's Signature
Printed Name
Date
BUILDING INFORMATION (PLANNING, ENGINEERING & BUILDING OFFICE USE ONLY)
Sq. Ft.: Fire flow requirement for structure:
PROJECT VALUE:
Notes and Conditions
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FIRE PERMIT APPLICATION (City of Liberty Lake)

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Completed 3 August 2020

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