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2. Date*
3. Full Name*
5. Company
6. Email Address*
8. Phone
9. Physical Address of Property*
11. Owner's Name*
12. Sq Ft of Structure*

    If an addition, please only provide SF of new portion of building. 

13. Type of Project

    (i.e.  New Structure, Addition, New Roof or Decking, etc )

15. Fire Sprinklers Present/Proposed

    1. Yes
    2. No
16. Distance from strucure to hydrant in feet*
17. Is the driveway >200 feet*

    1. Yes
    2. No
18. If so, does grade exceed 10%

    1. Yes
    2. No
20. Defensible Space

    As defined by IWUIC 2021 edition, defensible space is an area either natural or manmade, where material capable of allowing a fire to spread unchecked has been treated, cleared or modified to slow the rate and intensity of an advancing wildfire and to create an area for fire suppression operations to occur. 

22. Defensible Distance
    -- Select One --Less than 30 Feet30 Feet45 Feet50 Feet75 Feet100 Feet

    What distance of defensible space can be established from the proposed structure?   Please provide dimension from structure to property boundary or the furthest distance you are willing to modify fuels on your own property. 

24. Date of Take In

    If you have already scheduled your Take In with the Town or County Building Department, please indicate date here

26. Fire Hazard Rating

    A fire hazard rating  will be completed for the above address by this department. This rating, water compliance and the distance of defensible space will calculate the Ignition Resistant (IR) construction required for the structure construction. Details of IR requirements can be found on the contractor's page under the prevention tab at www.jhfire-ems.org. Once the area fire hazard rating and IR construction is determined, you will receive a IWUIC memo and hazard rating score sheet. This information will be sent electronically to the appropriate building department as well.

28. Site Plan*
    Please attached site plan
30. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
32. Electronic Signature*
33. Date*
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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field