Fire Pump Inspection Application

2. Application Date*
   Application Date

4. Applicant(s) Name*

6. Company

8. Address*

10. City*

11. State*

12. Zip*

14. Contact Phone*

15. Contact Email*

17. Project Name*

19. Project Address*

21. Permit Fee
    $75 Permit Fee. Cash or check made payable to "City of Daphne" only.

    $75 Permit Fee. Cash or check made payable to "City of Daphne" only.

23. Provisions
    Any person who services, tests or inspects fire pumps must be licensed by the Alabama State Fire Marshal’s Office and approved by the Fire Marshal. No person shall service, test or inspect a fire pump without first obtaining a permit from the City of Daphne Fire Marshal's office.

    Any person who services, tests or inspects fire pumps must be licensed by the Alabama State Fire Marshal’s Office and approved by the Fire Marshal. No person shall service, test or inspect a fire pump without first obtaining a permit from the City of Daphne Fire Marshal's office.

25. General Requirements:

    1. Current City of Daphne Business License
    2. General Liability Insurance for $1,000,000 with the City of Daphne listed as a certificate holder

27. Digital Signature*

28. Date*
    Date

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field