Contact Information:

Title: Select businessMr. Ms Mrs   First Name: (Required) Last Name: (Required)

Email: (Required)

Phone: Daytime (Required) Evening:

Event Information:

Date of Event: (Required)      Rain Date:

Address of Event: (Required)

City: State: Select One one AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA ME MD MI MO MN MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Postal Code:

Expected Number of People:

Expected Number of Vehicles:

Question 1:  Is this a new or existing business? New     Existing     Not Applicable     Company/Corporation Name: If new, consult the Department of Permitting Services for requirements. If existing, is there a valid Use and Occupancy Permit from DPS? Yes     No     Not Applicable

Question 2:  Is the event at a private house? Yes     No

Question 3:  Is this a public event? Yes     No

Question 4:  Will there be a tent? Yes     No

Question 5:  Will the event be inside or outside? Inside     Outside     Both

Question 6:  Will outdoor heaters be untilized? Yes     No

Question 7:  Will there be cooking on site? Yes     No

Question 8:  Will there be generators on site? Yes     No

Question 9:  Will there be fireworks? Yes     No

Question 10:  Will there be propane, diesel, gasoline, etc. on site? Yes     No

Question 11:  Will any streets be closed? Yes     No

Question 12:  Will there be any open flames of any kind including candles? Yes     No

Additional Comments or Information: