Los Angeles Fire Department

FEES

APPLICATION FOR HYDRANTS AND ACCESS (Please print legibly)

Person filling out this form information

(expediter, designer, engineer, architect, contractor, other)

Name of Company:

Phone:

Address: City:

State:

Print Name:

Signature:

Zip Code: Title:

Email Address:

LOCATION INFORMATION Address: Project's Name: Zip Code:

Date SFD PCIS #

APT Tract #

Other

City: LA

Phone:

Parcel Map #

PROPERTY OWNER / SPONSORING ORGANIZATION Name:

Phone:

Address: City:

Print Name:

State:

Signature:

Zip Code:

Title:

201 N. Figueroa St. Suite 300, Los Angeles, CA 90012

03-13-2020