KITSAP COUNTY FIRE MARSHAL OFFICE
SMOKE DETECTOR INSTALLATION CERTIFICATION FORM
614 Division Street MS-36, Port Orchard WA 98366-4682
(360) 337-7181

If you have any questions regarding this certification form, please contact KCFMO at (360) 337-7181.

I hereby attest and certify that in accordance with Kitsap County Ordinance No. 244-1999, Chapter 14.10, section 14.10.030 smoke detectors are properly installed in all bedrooms and hallways leading to bedrooms of my buildings, in accordance with the manufacturer recommendations, and tested for proper operation.

Name of complex:
Street Address:
Building Number:
Owner:
Owner Mailing Address:
Owner Telephone:
Name of Person or Company Installing Smoke Detectors:
Number of Smoke Detectors Existing in this Building Prior to 1/1/2000:
Number of Smoke Detectors Added in this Building After 1/1/2000:
Total Number of Smoke Detectors Currently Installed:
Date Installation was Completed:
Total Cost of New Detectors:

This certification submitted by Building Owner:

Name:
Telephone: