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HA WAIL FIRE DEPARTMENT site FIRE PRE VENTION B UREA U PaSanent Ainomit HILO: 25 litpitni St. Suite 2501, Hilo, HI 96 -20 (808) 932 -2913 or (808) 932 -2914 Rzczn zd B }: KOS4: -4 -5044 1ne Keohokalole HZiy, Bldg E. Kaihta -Kona, HI 96-40 (808) 323 -4 -60 Permit Nmnber For Plre Depa t nir Use Only AS'S'EMBLY PERMIT APPLICATION Completed application shall be submitted with payment to the Hilo or Kona fire prevention office. Payment may be cash or check. Checks shall be made out to `County Director of Finance'. (To be completed big applicant) Inspection Type: ❑Initial ❑Armual Date: Time: Business Name: TM -: Address: City /State: Zip Code: Applicant: Phone: Fax: E -Mail Address: Mailing Address for Permit: (To be completed big HFD) INSPECTION Place of Assembly Permit Posted: ❑ Yes ❑ No Maximum Capacity: Occupant Load Sign of Each Assembly Area Posted Near Main Exit(s) ❑Yes ❑ No Emergency Evacuation Plan Posted ❑ Yes ❑ No Exits Satisfactory ❑ Yes ❑ No Staff Proficient in Evacuation Training ❑Yes ❑ No Sprin1der Heads 18" from Storage ❑Yes ❑ No ❑N /A H.F.D. Access Satisfactory ❑Yes ❑ No Emergency Lighting Satisfactory ❑ Yes ❑ No ❑N /A F.D.C. Visible, Capped, & Accessible ❑Yes ❑ No ❑N /A Exits Signs Satisfactory ❑ Yes ❑ No Extinguishers Satisfactory ❑ Yes ❑ No Date Portable Fire Extinguishers Inspected: Inspected by: Fire Alarm Panel Satisfactory ❑ Yes ❑ No ❑N /A Date Inspected: Inspected by: Inspection Report Maintained on Site ❑ Yes ❑ No ❑N /A Sprinkler System Satisfactory ❑ Yes ❑ No ❑N /A Date Inspected: Inspected by: Inspection Report Maintained on Site ❑ Yes ❑ No ❑N /A Hood System UL300 Compliant ❑ Yes ❑ No ❑N /A Inspected by: Date Hood Suppression System Seiviced (within 6 months): Date Hood and Duct System Cleaned and Tagged: _ Cleaned by: Hood System Grease Inspection Required ❑Monthly ❑Quarterly ❑Semi- Armually Next Due Comments APPLICANT SIGNATURE: DATE: INSPECTOR SIGNATURE: Revised 4/13/2012 DATE: