TEXAS CITY FIRE DEPARTMENT
1725 25
TH
STREET NORTH, TEXAS CITY, TX 77590
Phone: 409-643-5700 FAX: 409-643-5719 Dispatch: 409-643-5721
Document Submittal Form
Date Submitted: _______/________/________
Month Day Year
Agency or Business Name _______________________________________________
Business Address: ______________________________________________________
Work Site Name:_____________________Site street Address:______________________
Documents Submitted By: _____________________________
Documents Submitted: __________________________________________________
Number of pages Submitted :____________
Phone: ________-_______-_______ Cell Phone: _______-_______-_______
Email: ________________________
Amount
Cash [ ] Check [ ] Document/Fee Received By
: _________________________________
_______________________________________ __________________________
Applicant Signature Date
______________________________________________________________________
**Below For Fire Department Use Only**
Notes regarding document submittal (If documents are in support of a permit request
please state below)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Fire Official that reviewed document
submittal:
________________________________
Date Documents Rcvd _____/____/____
Month Day Year
Review Completed _____/____/____
Month Day Year
Fee Required: $___________
Applicable fees must be paid prior to document review & permit issuance.
Note:
If requesting a permit you must complete a document submittal form & a permit application.
Print Name
ID #: ___________________
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