Palisades Fire Client Intake Form and Checklist

1. Client Information

Full Name: ________________________________________________

Previous Client: ____________________

Date: ___________

Phone Number: _______________

Email Address: ___________________________________

Current Address: ________________________________________________________________________________

Project Address: _________________________________________________________________________________

2. Client Status Checklist

1. Insurance – Have you begun the process with your Insurance Company:

   o Yes o No

2. FEMA – Have you filed with FEMA or other Federal, State and Local resources:

   o Yes o No o N/A

3. Previous Documentation: Do you have access to Previously Permitted Plans/Survey for your property:
   o Yes o No

4. Permit Expediting Services Required:
   o Parcel Permit History & Previously Approved Plans research and retreival
   o For New Project Submittal
   o Both

5. Potential Scope of Work for Rebuild:
   o Rebuild previous structures as permitted
   o Build to within 110% footprint of Previously Approved Structures o Build entirely new scope of work

6. Project Budget:
   
   ______________________
   

7. Project Timeline:
   
   ______________________
   

3. Additional Notes

_______________________________________________________________________