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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:


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

    This field is not part of the form submission.

46. Submit

* indicates a required field