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Amusement Permit Form

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Name of Carnival, Circus, or Show
Address1
Address2
City
State
Zip
Owner(s)
Person in Charge
Phone Number
Dates of Event
Permission Granted by
Parking / Traffic
Sponsor of Show
Phone Number
First Name
Last Name
Address1
Address2
City
State
Zip
Security
Name of Liability Insurance Co.
Amount of Insurance
Officers Hired
1. Yes
1. No
How many?
Health & Sanitation
Public Works Permits Needed
Health Permits Needed
Booth / Concessions
Office Use Only
This permit has been cleared by the following official signatures:
Fire Chief
Police Chief
Public Works Director
Health Official
Final Permission: City Manager
Date