Fillable LOCAL FIRE INSPECTION AUTHORITY INFORMATION REQUIRED BY THE (California)

Fill Online, Printable, Fillable, Blank LOCAL FIRE INSPECTION AUTHORITY INFORMATION REQUIRED BY THE (California) Form

Use Fill to complete blank online CALIFORNIA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

LOCAL FIRE INSPECTION AUTHORITY INFORMATION REQUIRED BY THE (California)

On average this form takes 2 minutes to complete

The LOCAL FIRE INSPECTION AUTHORITY INFORMATION REQUIRED BY THE (California) form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 7 other fields

Country of origin: US
File type: PDF

BROWSE CALIFORNIA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
STATE OF CALIFORNIA — HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
LOCAL FIRE INSPECTION AUTHORITY INFORMATION
REQUIRED BY THE DEPARTMENT OF
SOCIAL SERVICES, COMMUNITY CARE LICENSING
DIVISION
DATE:
APPLICANT NAME:
FACILITY NAME:
FACILITY ADDRESS:
As part of the application process, the licensing agency is responsible for obtaining a fire safety
inspection from the local fire inspection authority having jurisdiction in the area where your facility is
located.
To help us expedite this process, we are requiring that you identify the local fire inspection authority that
is responsible to inspect your facility and issue a fire clearance.
LOCAL FIRE INSPECTION AUTHORITY:
ADDRESS:
CITY AND ZIP CODE:
PLEASE RETURN THIS FORM WITH YOUR COMPLETED APPLICATION
LIC 9054 (3/99)
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

LOCAL FIRE INSPECTION AUTHORITY INFORMATION REQUIRED BY THE (California)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 10 April 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document