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2. Inspection Request & Billing Authorization Form Terms

   By submitting this "Inspection Request & Billing Authorization Form", you authorize Mountain View Fire and Rescue to bill the undersigned owner/ authorized agent for any inspection costs incurred relative to the location specified on this form, at a rate of $175/ hour. A minimum of one (1) hour will be charged. Partial hours thereafter will be prorated to the nearest quarter hour. Inspections will not be scheduled after standard office hours, on weekends, or federal holidays and must be mutually agreed upon. 

   The "Owner/ Authorized Agent" agrees to the inspection terms and agrees to pay for the requested inspection. Once completed and signed, an agent of the Fire Department will respond via email or phone (as provided below) to arrange for the inspection. 

   Once an invoice has been sent to the "Owner/ Authorized Agent" agrees to pay the full amount within 30 days from the date sent by the Fire District or their designee. 

4. Name of Business Where Inspection is Requested*
6. Address Where Inspection is Requested*
8. City
9. State
10. Zip Code
14. First Name (Authorized Owner/ Agent)*
15. Last Name (Authorized Owner/ Agent)*
17. Billing Address (if different from above)
19. City
20. State
21. Zip Code
23. Phone Number*
24. Alternate/ Cell Phone Number
26. Email Address*
28. 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.
30. Electronic Signature*
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field