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. Application Fee
    $75 Application Fee. Cash or check made payable to "City of Daphne" only.
19. Provisions
    No person shall engage in the business of servicing portable fire extinguishers without obtaining a permit from the City of Daphne Bureau of Fire Prevention. The permit is good only for that calendar year of which it was issued. The technician who performs the work of servicing the portable fire extinguishers shall legibly sign and date the service tag verifying that all work was done in compliance with current NFPA 10 standards.
21. 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
    3. Current Training Certificate (NICET) for all technicians (these must be submitted each year)
23. Agreement
    For installing and servicing of portable Fire Extinguishers in the City of Daphne, the below signed person/company agrees to install and maintain all fire extinguishers in accordance with the fire codes adopted by the City of Daphne. Permits are valid from January 1st to December 31st of each calendar year.
25. Digital Signature*
26. Date*
    Date
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field