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2. $35 Resident
4. Date
   Date

   Date
6. Applicant Name
8. Address
10. City
11. State
12. Zip Code
14. Phone
15. Date of Burn
    Date of Burn
17. Location of Burn
19. Time Requesting to Burn
21. Requestor's eSignature
23. Please note:
    This is not a permit. It is only a request for a permit. Burning is prohibited until a signed burn permit is obtained from the Fire Marshal or designated representative. Failure to comply with the City established ordinances can be punishable of a fine not to exceed $2,000 per violation per day.
25. Permit Number
26. Form Accepted By:
27. Date
    Date
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field