Inspection Application Form
Please select the island or region you are applying from
*
St. Thomas
St. John
St. Croix
Each business and/or individual must have a fire extinguisher available upon inspection
*
I understand
TYPE OF BUSINESS INSPECTION
New
Existing
Home
Government
DLCA Form
Licensee:
Licensee Phone:
Occupancy Square Footage:
Business Name:
Business Physical Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Mailing Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone:
Please enter a valid phone number.
Format: (000) 000-0000.
Business Operational Hours:
Contact Person:
First Name
Last Name
Contact Person Phone:
Please enter a valid phone number.
Format: (000) 000-0000.
Type of Business:
Directions to Business:
Hazardous Materials Ex (I.P. Gas, Chlorine, Flammable Liquids, Solvents etc.)
Yes
No
Type(s)
Quantities:
Sprinkler System:
Yes
No
Fire Alarm:
Yes
No
Fire Pump:
Yes
No
Fire Alarm Company:
PH:
Applicant's Signature:
*
Date:
*
-
Month
-
Day
Year
Date
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Next
Continue
Continue
For Official Use Only
Inspection Fee:
Late Fee:
Time Consumed:
Total Paid:
Date:
-
Month
-
Day
Year
Date
Receipt #:
Certificate No.
Expiration Date:
-
Month
-
Day
Year
Date
Proposed Inspection Date:
-
Month
-
Day
Year
Date
Inspected By:
First Name
Last Name
Date:
-
Month
-
Day
Year
Date
Approved
Disapproved
Comments:
Re-Inspection
Fee:
Date Paid:
-
Month
-
Day
Year
Date
Receipt #:
Inspected By:
First Name
Last Name
Date:
-
Month
-
Day
Year
Date
Approved
Disapproved
Certificate Received By:
First Name
Last Name
Signature
Authorized Representative:
First Name
Last Name
Signature
Should be Empty: