2. First Name
3. Last Name
5. Phone Number:
6. Email:
7. Type of Business
9. Location of Permit
11. Name of Business
13. Billing Address
14. Project Name
16. Please state the intended use of the building, structure, or operation to be conducted on these premises:
18. Have plans been submitted to the Fire Official:

    1. Yes
    2. No
20. All permits issued under this code shall require that the applicant, his agents and employees carry out the proposed activity in compliance with all the requirements of this code and any other laws or regulations applicable thereto, whether specified in the permit or not in complete accordance with the approved plan and application.
22. File Upload
    Attach any plans for approval.
24. This permit will be revoked if:
    • The permit is used for a location or establishment other than for which was issued.
    • Conditions and limitations set forth in the permit have been violated.
    • There has been any false statements or misrepresentations as to a material fact in the application for permit or plans submitted or a condition of the permit.
    • The permit is used by a different person or firm other than the name for which it was issued.
26. Signature of Applicant
27. Date
29. Approved Permit Number
30. Date Approved
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field