Fillable Printable Fire service application sample form

Fire service application sample form

Fire service application

Property details

Property Account Number:

Lot: House: Street name:

Suburb: Nearest cross street:

Applicant details

Company name: Contact name:

Address:

Would you prefer all future correspondence for this application to be e-mailed? Y / N

If yes please supply e-mail address:

Phone / Mobile: Fax:

Owner/developer (person responsible for payment of ongoing accounts

)

Company name: Contact name:

Address:

Would you prefer all future correspondence for this application to be e-mailed? Y / N

If yes please supply e-mail address:

Phone / Mobile: Fax:

This application is for an existing / proposed:

(Circle Applicable) (For example, Warehouse, laundry, hospital, etc)

Fire service size required: Mm

Note: Water Corporation is unable to guarantee the flow rate and pressure for firefighting purposes

Taking of water without or contrary to approval is in breach of the Water Services Act 2012 (Section 89) and

may result in prosecution.

Service location details

Please describe where the fire service is to be located as if you are

standing in the street looking at the property and specify the distance

from the closest boundary. E.g. install service 5 metres from left hand

boundary on John St.

Left Boundary

Rear Boundary

Right Boundary

Existing Building

Street Front

Signed: Name: Date _____/_____/_____

Your privacy

Information collected on this form will be used for the purposes directly related to the service you have

requested. Information may be shared with local government authorities, government agencies and to

service providers in order to provide the service you have requested. Your prior consent will be sought

for any other proposed disclosure.

Please submit your request via one of the following options:

Online: xxx xxx and select BuilderNet.

Email:

xxx xxx

Fax: xxx xxx Mail: Building Services

Water Corporation

PO Box 100

Leederville WA 6902