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Fire Protection Permit

2. Company / Contractor

4. Address

6. City

7. State

8. Zip Code

10. Email

11. Phone

13. Cell Phone

14. Fax

16. Site Information

18. Project Name

20. Project Address

22. City

23. State

24. Zip Code

26. Owner Name

28. Owner Address

30. City

31. State

32. Zip Code

34. Phone

36. Construction Type

    1. Addition to Building
    2. Alteration of Existing
    3. New Construction
    4. Replace / Repair Existing

37. Check One:

    1. Chemical - Wet or Dry
    2. Fire Alarm Permit
    3. Fire Suppression Permit
    4. Other

38. If other, please clarify:

40. Indicate number of devices to be installed and/or altered:

42. Number of Sprinkler Heads

44. Number of Fire Alarms, Stations

46. Number of Horns, Strobes, or Other

48. Total Devices

50. Fees
    Liberty Township Fire Department

    Liberty Township Fire Department

52. Plan Review Fee

    Plan Review Fee

53. $100 (Per System)

    $100 (Per System)

55. Construction Inspection Fee

    Construction Inspection Fee

56. $200 (Per System)

    $200 (Per System)

58. Liberty Township Administration Fee

    Liberty Township Administration Fee

59. $25

    $25

61. Total

    Make Payable to Liberty Township

63. Signature of Certified Contractor or Authorized Agent:

64. Date
    Date

Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit

* indicates a required field