White – Office Copy – Customer
City of Huntington Beach
Community Services Department
2000 Main Street
Huntington Beach, CA 92648-2702
(714) 536-5486
Bounce House Special Permit
Event Date: Time: From To
Applicant Name: Phone:
Organization: Phone:
Applicants Address:
NUMBER STREET CITY STATE ZIP
Email Address: ___________________________________________________________________________
Name of Park: __________________________ Type of Event:
Location in Park: _________________________________________________________________________
Number of Participants: _________ Bounce House Company: _______________________________
Initial X___________ I, the above mentioned, understand that this permit allows me to place an approved inflatable item
at a Huntington Beach City park on a first come, first served basis.
Initial X___________ I, the above mentioned, understand that a generator must be used to power permitted inflatables at
all times in Huntington Beach city parks. I understand that there are no exceptions to this rule.
Initial X___________ I, understand that this permit is non-refundable.
Additional Information:
NOTE: If other expenses occur not covered herein, additional charges will be made accordingly.
I agree to abide by all laws, rules and regulations which may apply to this area. I accept specific responsibility
for other members of my group and for any damage done to city property and/or facilities.
APPLICANT’S SIGNATURE DATE
Keep a copy of this permit with you in case of questioning by an official.
For City Use Only
Fees Required
□ Permit Fees $
□ Other $
□ No Fees Required
Received, Issued, & Approved by:
Email to Gretchen Erickson or Faxed Copy to Park Maintenance X 8877 Date processed ____________
