500 Dalton Avenue
Charlotte, NC 28206
NOTE: If you have not yet been issued a CFD System ID #, as requested below, enter a "0". This number will be supplied in the near future by your area fire inspector during the next routine inspection.
You must provide the name of the impairment coordinator (using generic terms such as "security" is not sufficient) and you must provide a description and reason for impairment.
ID# on the Alarm Panel Notification Requirement sticker affixed by Fire Prevention Bureau Inspectors. If no number issued, enter "0".
Legal Full Name (as you would sign):
Valid Email Address: