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PLC:

a0057o

Agency:

lake country fire and rescue

For:

sprinkler review and testing

Phone:

262-303-4524

Address:

115 main street
delafield, wisconsin 53018

*Required Field

Payment Information

*Contractor Name:

Middle:

*Last:

*Project Business Name:

*Contractor Cell/Contact Number:

(### - ### - ####)

*Contractor Email Address:

*Basic Fire Sprinkler Plan Review - $315.00 (Please enter Yes or No in the space below):

*Sprinkler Heads - $2.65 per head (Please enter Total number of Sprinkler Heads needed in space below):

*Witness 2-hour hydrostatic test - $195.00 (Please enter Yes or No in the space below):

*Witness final acceptance test of fire sprinkler system - $195.00 (Please enter Yes or No in the space below):

Any cost incurred by LCFR to prepare a complete plan review shall be paid in advance by the permit applicant

Payment Amount

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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