Kearney Special Use 3 Day Permit

DOWNLOAD Kearney Special Use 3 Day Permit

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Date*

Address*

County State

Owner and Contact Information:

Full Name*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Operator Information:

Full Name*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Location:

Address*

Street Address Address Line 2 City State ZIP Code

Property Owner Information

Full Name*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

All tents and temporary structures must comply with the 2012 International Fire Code and all applicable NFPA standards

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Office Use

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Approved By Signature

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Date

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Printed Name:

First Name Last Name

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Expiration Date

Name

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