OPEN FLAME PERMIT

Sponsoring Group:

Event Coordinator:

Event:

Date(s):

Time(s):

Location:

Type of Open Flame (Check appropriate box(es)

 Candle       Lantern      Lamp         Sterno

 Propane     Potpourri   Other

If Other, Specify:

Name(s) of Fire Watch:

Issue Date of Permit:

Permit Issued By:

(Building Coordinator)

Permit Received By:

(Event Coordinator