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Fire Watch Notice

  1. The undersigned hereby acknowledges that he/she has been informed by the City of Carbondale Fire Department that the fire protection system located at the below address is not functioning properly. The undersigned hereby agrees to accept the responsibility for keeping a 24-hour per day watch of the building to insure alarms are promptly reported to the Fire Department. Such 24-hour per day watch shall be maintained until the City of Carbondale Fire Department determines that the fire protection system is operating properly.

  2. The undersigned acknowledges that if the fire protection system is not operating properly within the date/time listed below, or if the 24-hour per day watch is discontinued for any length of time, the City of Carbondale Fire Department, pursuant to the International Fire Code 2003, Chapter 9, as adopted by Carbondale Revised Code, Chapter 8-1-1, shall prohibit occupancy of the structure until the inoperative system is repaired and returned to service.

  3. 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.

  4. Contact CFD Office at (618) 457-3234 after repairs have been made.

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  6. This field is not part of the form submission.