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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
52. Plan Review Fee
53. $100 (Per System)
55. Construction Inspection Fee
56. $200 (Per System)
58. Liberty Township Administration Fee
59. $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