2. Application Date*
   MM/DD/YYYY
3. Business Name*
5. Permit Address: *
7. City*
8. State*
9. Zip*
13. Permit Needed*

    Please check appropriate box(es)

    1. Amusement Building
    2. Block Party
    3. Carnival or Fair
    4. Compressed Gases (over 200 cubic feet)
    5. Exhibits and Trade Shows
    6. Fire Protection or Detection Systems
    7. Flammable and Combustible Liquids
    8. Hazardous Materials

    1. High-piled Storage (over 12 feet)
    2. Open Burning
    3. Open Flames or candles in Assembly Occupancies
    4. Pryotechnic or Fireworks Display
    5. Repair Garage and Fueling Station
    6. Tents and Membrane Structures
    7. Vehicle Displays in Public Buildings
15. Plans, documents, and specifications to be reviewed:
    Attach any documents to be reviewed for permit. Fire Systems reviewed by 3rd party (from approved list) must include PDF image of stamped reviewed documents. One plan set is also required.
17. Additional Documents
    Add additional documents here.
19. Time Period of Permit*
    -- Select One --PermanentTemporary
20. Type of Permit*
    -- Select One --Operational Construction
24. Applicant Information
26. Applicant First Name*
27. Applicant Last Name*
28. Applicant Title
30. Applicant Phone Number*
31. Applicant Email Address*
33. Name of Venue*
34. Name of Event*
35. Event Date*
37. Details of Event or Process
    Type in details about the event or process in the box above.
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field