1725 25
Phone: 409-643-5700 FAX: 409-643-5719
General Permit
Type of Permit Requested:
Fire Alarm System, Alarm Re-Test, Above Ground Storage Tank, Dry Cleaning
plant, Flammable finishes booth, Day Care, Suppression system, Sprinkler
System, Underground Sprinkler Supply, Open Burn, Trench Burn, Explosive or
Fireworks use/transport/storage, Tent, O2/Compressed gas dispensing, Fuel disp.
Date Issued: ________________ Fire Official_______________________
ID #: ____________________
Date Expires: _______________ Permit #: _______________________
Business and/Applicant Name: ____________________________________________
Business Address: ______________________________________________________
Operation Location: _____________________________________________________
Phone: ________-_______-_______ Cell Phone: _______-_______-_______
Fee Required: $___________ Applicable fees must be paid prior to permit issuance.
Cash [ ] Check [ ] Fee Received By: _________________________________
Details regarding the above request must be filed when application is made and
whenever requested by the Fire Official. It is the applicant’s responsibility to ensure that
conditions are in accordance with applicable State and Local fire regulations. I
understand that it is the sole discretion of the Fire Official making inspection to
approve or disapprove this request for any reason.
I understand that the Fire Official may revoke this permit at any time for non-compliance.
Note: Operating with no permit or an expired permit may result in double permit fees.
Applicant may not proceed without the approved permit by Fire Official.
_______________________________________ __________________________
Applicant Signature & Print Name Date
Email Address:_________________________________
**For Fire Department Use Only**
Notes regarding Inspection (If disapproved, state reasons)_________________________
Approved: [ ] Yes [ ] No
** Permit must be kept at site at all times **
Date Application Rcvd _____/____/____
Month Day Year
Save and email to dharris@texas-city-tx.org
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