2. Application Date*
   Application Date
4. Company
6. Contact Name*
8. Address*
10. City*
11. State*
12. Zip*
14. Contact Phone*
15. Contact Email*
17. Project Name*
19. Project Address*
21. Project Phone*
22. Project Email*
24. Name of System Manufacturer*
26. Application Fee
    $75 Application Fee for the year issued. Cash or check made payable to "City of Daphne" only.
28. General Requirements

    1. Any modifications made to a fixed system including adding additional flow points will require an installation permit
    2. The technician shall be trained and certified by the system manufacturer being (listed above) and copies of the training shall be submitted to the Fire Marshal
    3. Any system taken out of service or tagged as non-compliant shall require that the Fire Marshal be notified immediately
30. Digital Signature*
31. Date*
    Date
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field