Fillable Lpginstallationapplicationforinternet

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Lpginstallationapplicationforinternet

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File type: PDF

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LAKE HAVASU CITY FIRE DEPARTMENT
Fire Prevention Bureau
2330 McCulloch Blvd. N.
Lake Havasu City, AZ 86403
(928) 855-1141 lhcfire@lhcaz.gov
FD-211 Updated/CA 10-01-2019
Liquefied Petroleum Gas (LPG)
Installation Application
Property Address:
Property Owner:
Phone:
Plumbing Contractor:
Phone:
LPG Supplier:
Phone:
List Appliances Served:
Tank Size:
Distance from tank to:
Property line:
Structure:
Appliance:
DRAW SITE DIAGRAM BELOW OR ATTACH SITE PLAN
Applicant accepts responsibility that the work conducted under this permit will conform in all respects to the plans submitted in conjunction
with this application and that all work will be done in accordance with all applicable laws and City Codes. Applicant is responsible to obtain
utility approval. Fire Department approval is subject to field inspection.
NOTE: ALL UNDERGROUND PIPING SHALL REMAIN EXPOSED UNTIL INSPECTION IS COMPLETED AND APPROVED.
Applicant:
Property Owner
Plumbing Contractor
LPG Supplier
Applicant Signature:
Date:
Inspection comments:
TO BE COMPLETED BY FIRE PREVENTION BUREAU
Application approved by:
Date:
Approved for use by:
Date:
Permit #:
Inspection scheduled:
Yes
No
Inspection
date:
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Lpginstallationapplicationforinternet

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Completed 13 July 2020

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