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2. All residents within the City of Norfolk should have a working smoke alarm in their home to notify them immediately of smoke or fire in their home. If the home does not have a working alarm or the existing alarm is more than 10 years old, call 757-664-6510 to request a free smoke alarm to be installed by the closest fire station.
4. Date*
   Date
6. First Name*
7. Last Name*
9. Email
11. Street Address*
13. Zip*
15. Phone*
16. Alternative Phone
18. # of Floors In Home:*
19. # of Working Smoke Detectors:
20. # of Adults:*
22. # of Children (Include Overnight Grandchildren):*
23. # of Senior Citizens:
25. Do you and your family have a fire escape plan?*

    1. Yes
    2. No
26. Have you ever experienced a house fire?*

    1. Yes
    2. No
28. Do you own or rent?*

    1. Own
    2. Rent
29. If you answered yes, please provide name and contact number of your landlord.
30. Housing Selection*

    1. Single Family
    2. Townhouse
    3. Condo
    4. Apartment
    5. Duplex
32. Do you or anyone in your household require a hearing impaired smoke alarm?*

    1. Yes
    2. No
34. 
    Whether you live in a rented house or apartment, your landlord is required to provide you with a working smoke alarm. Tenants are responsible for maintaining the smoke alarm(s) in good working condition.
    
    If your rental property does not have a smoke alarm, inform your landlord of this obligation. If you are having difficulty communicating with your landlord about this matter the following contact information may be of assistance:

    
    Norfolk Fire-Rescue
    Fire Marshal's Office
    100 Brooke Avenue
    Suite 400
    Norfolk, VA 23510
    Phone: 757-664-6604
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

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