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LOS ANGELES FIRE DEPARTMENT Bureau of Fire Prevention & Public Safety

PUBLIC ASSEMBLAGE UNIT 200 N. Main Street, Suite 1700 Los Angeles, CA 90012 (213) 978-3650

6262 Van Nuys Boulevard, Room 451 Los Angeles, CA 91401 (818) 374-1110

APPLICATION FOR SPECIFIC ACTION PERMIT LOCATION INFORMATION Address

Date(s) of Use

FIRE DEPARTMENT USE ONLY

Date Granted

Permit #

Date Expired Name

Phone

City

State

Zip Code CONTRACTOR INFORMATION

Name

Phone

Address City

State

Print Name

Zip Code

Signature

Title

PROPERTY OWNER / SPONSORING ORGANIZATION Name

Phone

Address City

State

Print Name

Zip Code

Signature

Title

*Do not write below this line* Inspector Signature

FIRE MARSHAL

Date

Unit Public Assemblage Phone ITEM

CODE

QTY

FEE

Fireworks – Ground Display

3888238

$387.00

Fireworks – Aerial Burst (Not over 6”)

3888239

$516.00

Fireworks – Aerial Burst (Over 6”)

3888240

$1,032.00

Exhibit, Shows, Circus or Carnival

3888242

$774.00

Tent – 401 to 3,450 Sq Ft (Enclosed)

3888243

$516.00

Tent – 3,501 to 25,000 Sq Ft

3888244

$1,032.00

Tent – Over 25,000 Sq Ft

3888245

$2,064.00

Farmers Market

3888257

$624.00

Operate or Maintain Live Theater < 99

3888253

$516.00

Operate or Maintain Live Theater > 99

3888254

$1,032.00

Permit will not be valid unless signed by Fire Marshal. EMS & Receipts Unit 200 N. Main, City Hall East 16th Floor, Room #1620 HOURS 7:30AM – 4:30PM Monday through Friday

TOTAL FEES **EFFECTIVE JAN 2, 2020**

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