Fillable Fire Protection And Safety Agreement Form PDF (Elbert County Government)

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Fire Protection And Safety Agreement Form PDF (Elbert County Government)

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FIRE PROTECTION AND SAFETY AGREEMENT FORM
Community & Development Services, Elbert County, Colorado
P.O. Box 7, 215 Comanche St. Kiowa, CO 80117 ● (303) 621-3185 ● Fax (303) 621-3165 ● www.elbertcounty-co.gov
This form is designed to accompany Land Development Applications submitted to Elbert County Community and Development
Services and serves as Proof of Fire Protection for Land Development Review. PLEASE COMPLETE ALL BOXES
Applicant Name:
Address & Zip Code:
Phone:
Email:
Property Owner:
Address & Zip Code:
Phone:
Email:
Subject Property Address:
CHECK ONE:
□ The subject property is located within the fire protection district.
□ The subject property is located outside a fire protection district.
If the subject property is located outside a fire protection district, a contract with a district providing for fire protection to the property
will be required. The applicant has met with the following fire protection district to discuss fire district requirements.
FIRE PROTECTION DISTRICT SERVING THE SUBJECT PROPERTY: .
Authorized Representative: Title: .
Authorized Signature ____________________________________ Date: ___________________
APPLICANT AGREEMENT: I am aware of the adopted fire code and will comply with the requirements of the fire district.
Applicant’s Signature ____________________________________ Date: ___________________
FIRE PROTECTION DISTRICTS SERVING ELBERT COUNTY:
□
AGATE FIRE PROTECTION DISTRICT
40160 County Road 153 / P.O. Box 146
Agate, CO 80101
(719) 764-2771
□
BIG SANDY FIRE PROTECTION DISTRICT/
SIMLA VOLUNTEER FIRE DEPARTMENT
219 Sioux Avenue / P.O. Box 161
Simla, CO 80835
(719) 541-2883
□
CALHAN FIRE PROTECTION DISTRICT
725 4th Street
Calhan, CO 80808
(719) 347-3057
□
DEER TRAIL RURAL FIRE PROTECTION
DISTRICT
488 1st Avenue / P.O. Box 257
Deer Trail, CO
(303) 769-4748
□
ELBERT FIRE PROTECTION DISTRICT
24310 Main Street / P.O. Box 98
Elbert, CO 80106
(303) 648-3000
□
ELIZABETH FIRE RESCUE
155 West Kiowa Avenue / P.O. Box 441
Elizabeth, CO 80107
(303) 646-3800
□
KIOWA FIRE PROTECTION DISTRICT
403 County Road 45 / P.O. Box 321
Kiowa, CO 80117
(303) 621-2233
□
LIMON AREA FIRE PROTECTION
DISTRICT
130 C Avenue/ P.O. Box 3
Limon, CO 80828
(719) 775-8155
□
NORTH CENTRAL FIRE DEPARTMENT
40144 Ridge Road
Deer Trail, CO 80105
(303) 621-0109
□
RATTLESNAKE FIRE DEPARTMENT
46200 Coal Creek Drive
Parker, CO 80138
(303) 841-8111
□
TRI-COUNTY VOLUNTEER FIRE
DEPARTMENT & FIRE PROTECTION
DISTRICT
590 N Rush Road / P.O. Box 97
Rush, Colorado 80833
(719) 478-2345
Elbert County Fire Protection and Safety Agreement Form – 4/9/2018 – Page 1 of 1
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Fire Protection And Safety Agreement Form PDF (Elbert County Government)

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Completed 21 January 2021

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