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–
Step
1
of 3
Part One
Company Information
*
Corporation
LLC
Sole Proprietor
LLP
General Partnership
Company Name
*
DBA
*
Responsible Person
*
First
Last
Responsible Person Certification
Business Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Same as Business Address
Mailing Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Business Phone
*
Cell Phone
Email
*
Website / URL
Part Two
Business Certification
License Class
*
A
A-12
A-17
C-4
CR-11
C-11
C-16
CR-16
C-37
CR-37
C-39
CR-39
C-67
CR-67
C-74
C-77
CR-80
Central Station UL
Central Station FM
GROL
IKECA
KA
R-11
R-16
R-37
OTHER
License Number
*
Exp. Date
*
License Class
A
A-12
A-17
C-4
CR-11
C-11
C-16
CR-16
C-37
CR-37
C-39
CR-39
C-67
CR-67
C-74
C-77
CR-80
Central Station UL
Central Station FM
GROL
IKECA
KA
R-11
R-16
R-37
OTHER
License Number
Exp. Date
License Class
A
A-12
A-17
C-4
CR-11
C-11
C-16
CR-16
C-37
CR-37
C-39
CR-39
C-67
CR-67
C-74
C-77
CR-80
Central Station UL
Central Station FM
GROL
IKECA
KA
R-11
R-16
R-37
OTHER
License Number
Exp. Date
Next
Part Three
Services and Systems
Alternative Fire Suppression System (i.e. Foam, Wet & Dry Chem, Halon, CO2, etc.
Yes
No
Alternative Fire Suppression Services Provided
Installation
Inspections
Service/Repair
Emergency Responder Radio Coverage System/BDA
Yes
No
Emergency Responder Radio Coverage/BDA Services Provided
Installation
Inspections
Service/Repair
Site Surveys
Carbon Dioxide (CO2) System Detection and Monitoring
Yes
No
Carbon Dioxide (CO2) System Services Provided
Installation
Service/Repair
Fire Alarm Monitoring – Central Station
Yes
No
Central Station Certification Number
Fire Alarm Systems
Yes
No
Fire Alarm System Services Provided
Installation
Service/Repair
Fire Sprinklers – Commercial
Yes
No
Fire Sprinklers -Commercial Services Provided
Installation
Service/Repair
Fire Sprinklers – Residential
Yes
No
Fire Sprinklers – Residential Services Provided
Installation
Service/Repair
Fire Extinguishers
Yes
No
Fire Extinguisher Services Provided
Installation
Service/Repair
Underground Fire Lines
Yes
No
Underground Fire Lines Services Provided
Installation & Retrofit
Decomissioning
Interior Lining
Tightness Testing
Cathodic Protection Testing
Part Four
Certifications and Licenses
ADEQ Certification Number
Does your organization perform work in buildings owned and/or operated by Sun City Fire Department or Youngtown?
Yes
No
Next
Part Four
I (we) hereby make application for a permit to provide the products and/services described above, pursuant to The International Fire and Building Code, (IFC and IBC). I (we) agree to service, install and/or repair fire protection equipment in accordance with the applicable provisions of the International Fire Code and the appropriate standards of the National Fire Protection Association. I (we) further understand that issuance of approval does not constitute recommendation of my (our) company by the Sun City Fire and Medical Department and I (we) agree not to use such permit in said manner.
Name
*
First
Last
Title
*
Date / Time
*
Email
*
Provide email address for invoice to be sent.
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