1

Operational Permit Type 

Operational Permit Type (Select an Answer) Amusement Buildings Carnivals and Fairs Places of Assembly Temporary Tent Outdoor Assembly Event Explosives Pyrotechnic Special Effects Material Exhibits and Trade Shows Open Burning Special Event Structure

2

Set-up Date

Set-up Date

3

Dates of Operation

Dates of Operation

4

Applicant Information

 *

Applicant Information

Company name

Address

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip code

Contact Name

Office numberext.

Cell numberext.

Email

5

Permit Location and Responsible Party (IF DIFFERENT THAN APPLICANT INFORMATION)

Permit Location and Responsible Party (IF DIFFERENT THAN APPLICANT INFORMATION)

Business Name

Address

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Contact Name

Office numberext.

Cell numberext.

Email

Please send all mandatory supporting documents to fireplanreview@tempe.gov

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2. Email Address

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