Application For Fire Extinguisher Servicing Individual License - City Of Auburn
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Fire Extinguisher with Exam
$45.00
Planning and Development
Fire Extinguisher without Exam
$30.00
25 West Main Street
Renewal of Fire Extinguisher Servicing License $20.00
Auburn, WA 98001
Phone: (253) 931-3090
Business License Fee
$50.00
Fax:
(253) 804-3114
Business License Renewal fee
$50.00
FIRE EXTINGUISHER SERVICING
APPLICATION FOR
INDIVIDUAL LICENSE
The Auburn Municipal Code requires that business activity which meet the criteria for individual licenses be applied for in
addition to a City of Auburn business registration from the City Clerk’s office. City of Auburn business registrations and
st
individual licenses are required to be renewed by December 31
of each year.
CHECKLIST/REQUIREMENTS:
CERTIFICATE OF EXAMINATION:
Valid license or certification from other jurisdictions is acceptable to the
Certificate of Examination
Yes
No
Certificate # __________________
Fire marshal.
Where:
TYPE OF LICENSE:
Master
Agent
FIRE EXTINGUISHER SERVICING BUSINESS INFORMATION:
Name:
Address:
City:
State:
Zip:
Telephone:
APPLICANT’S INFORMATION:
Name:
Address:
City:
State:
Zip:
Telephone:
Maiden Name:
Alias/Previous Name:
Drivers License No.:
Eye Color:
Hair Color:
Sex: M
F
HT:
WT:
Social Security No.:
Date of Birth:
Place of Birth:
U.S. Citizen: Yes
No
If no, please indicate status:
Previous Home Address Past (5) years:
1.
2.
Previous Employment Past (5) years:
1.
2.
STATE OF WASHINGTON
COUNTY OF KING
I, _______________________________________, being first duly sworn, on oath deposes and says: I am the above named applicant
and make this affidavit for the purpose of obtaining from the City of Auburn a FIRE EXTINGUISHER SERVICING individual
license. I have personal knowledge of the matters stated in the individual license application, and the statements therein contained are
true. I have read the individual license regulation in Auburn City Code 8.24 and the legal requirements contained therein.
I, _______________________________________, hereby give permission to the City of Auburn to conduct an investigation into my
background. I waive any and all claims against any company, corporation or individual pertaining to information received from such
company, corporation or individual by the city as a result of such investigation.
___________________________________________
Signature of Applicant
Subscribed and sworn before me this _____date of___________________,
20___, Notary Public in and for the State of Washington, residing
at______________________. My Commission Expires:____/____/_____
:__________________________________________
Signature
FOR OFFICE USE ONLY:
Planning__________________
Date Received: ____________________
Building__________________
Amount Paid: _____________________
Fire______________________
TR Receipt #:______________________
Police____________________
Business License #:________________
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