Page - 1 - of 3
V1.0
FIRE SERVICES PERMITSPECIAL EVENT
ADDRESS OF EVENT (INCLUDE ADDRESS #, STREET NAME, & DIRECTIONAL), Apt/Unit#
APPLICANT
APPLICANT or BUSINESS NAME (applicant is:
Owner
Contractor
Other)
REPRESENTATIVE NAME (if applicable)
PHONE
OPERATOR NAME
PHONE
ADDRESS (cannot be PO Box or commercial mailing service)
CITY
STATE
ZIP
EMAIL ADDRESS
EVENT INFORMATION
EVENT NAME
EVENT START TIME & DATE
EVENT END TIME & DATE
APPROXIMATE SET UP TIME
PERMIT INFORMATION
check all that apply please be aware that events requiring a fire watch require an extra fee
Amusement Building ($75.40) Open Flame or Candles in Assembly Area ($75.40)
Bonfire one time ($75.40) Pyrotechnical Effects ($150.70)
Controlled Burn ($75.40)
Temporary Conditional Use (Complete Policy 10-6)
Exhibits & Trade Shows ($150.70) Temporary LP Usage ($75.40 per tank)
Fireworks Display outdoor/explosive ($301.40) Tent & Other Membrane Structure ($75.40)
HOW WILL PRODUCT BE TRANSPORTED TO EVENT
HOW WILL PRODUCT BE STORED AT EVENT
Application Form
Special Event
Permit
Regulatory Services
250 South 4
th
Street Room 300
Minneapolis, MN 55415
Office 612-673-3000 or 311
Fax 612-673-3699
TTY 612-673-2157
Office Use Only
Permit #__________________________________________________
Amount $_________________________________________________
Inspector Initials___________ Date___________________________
Page - 2 - of 3
V1.0
REQUIRED INFORMATION
the following must accompany the permit application form
FOR EXHIBITS & TRADE SHOWS, TENT &
OTHER MEMBRANE STRUCTURES, AND
TEMPORARY ASSEMBLY PERMITS
FOR TENT & OTHER MEMBRANCE
STRUCTURE PERMITS
FOR FIREWORKS DISPLAY AND
PYROTECHNICAL EFFECT PERMITS
A detailed floor plan showing the means of
egress, seating arrangements, extinguisher
placement, and the location and type of
heating and electrical equipment. Include the
location and separation distance of other
nearby structures.
Type of structure: ___________________
Size of structure: ____________________
Proof of flame-resistant treatment of tent
or membrane structure per NFPA 801.
Certificate of Public Liability Insurance
Shooter’s License & Minnesota License
Site Plan
The undersigned hereby agrees that all information on this application is true and correct, and to comply with all applicable city ordinances, state and
federal rules, and all orders from Minneapolis Fire Inspections Services.
SIGNATURE ______________________________________________________________________ DATE __________________________________
Page - 3 - of 3
V1.0
PAYMENT OPTIONS
In person at the Minneapolis Development Review counter, Monday through Friday, 9:00 AM to 3:00 PM:
Public Service Center
250 South 4
th
Street, Room 300
Minneapolis, MN 55415
By mail, with a check payable to Minneapolis Finance Department,
or the below credit or debit card information, mailed to:
Fire Inspection Services
250 South 4
th
Street, Room 300
Minneapolis, MN 55415
MasterCard or Visa only
Card Number _______________________________
Expiration Date ________ CVV ________
By secure fax, with the below credit or debit card information:
MasterCard or Visa only
Card Number _______________________________
Expiration Date ________ CVV ________
Secure fax to 612-673-3699