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FIREPERMITSPECIALEVENT

FIREPREVENTIONDIVISION

Assembly, candle, canopy, open flame, tent,


Organization: Name of Activity: Date(s) of Activity: Location of Activity: Description of Activity: Permit # S

This permit is to be used for the above date(s) and activity only. The area shall be restored to its original conditions following the event. Comply with 2007 California Fire Codes, California Code of Regulations, Title 19 and the following conditions. (ForFirePreventionOfficeUseOnly)CONDITIONSORREQUIREMENTS:

Applicant: Signature:

Title: ContactPhone: ContactEmail:

IssuedBy: Signature:

Title: ContactPhone:

For general information, contact 642-5995 or 642-9529. FAX number: 643-7595

Page 2 3/7/2013

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