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Fire Prevention Permit Request

2. Fire Prevention Permit Request

4. You will be contacted to once the information has been processed to arrange for payment of permit fees and issuance of permit.

6. Organization/Individual Requesting Permit Information

8. First Name*

9. Last Name*

11. Business Name (If Applicable)

13. Business Address*

15. City*

16. State*

17. Zip*

19. Phone Number*

20. Date of Request
    Date of Request

    Date of Request

22. E-Mail Address

23. Preferred Method of Contact
    -- Select One --PhoneE-Mail

27. Information for Location of Permit Utilization

29. Name of Individual/Organization*

31. Location for Permit Utilization

33. City

34. State

35. Zip

37. Type of Permit Requested

    1. Hot Work Operations ($50)
    2. Open Burning ($50)
    3. Temporary Tent/Canopy ($50)
    4. Automatic Fire Extinguishing System/Fire Pump Installation ($100 + $2 per device)*
    5. Fire Alarm/Detection System ($100 + $2 per device)*
    6. Other (Please describe in Additional Comments/Information Section)

38. Additional Comments/Information

40. Account Number 5310-435299

42. * Please List Number of Devices in Comments Section

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field