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2. 
4. Resident First Name*
6. Resident Last Name*
8. Property Owner First Name (if different than Resident)
10. Property Owner Last Name (if different than Resident)
12. Address*
14. City*
15. State*
16. Zip Code*
18. Phone*
19. Email
21. I have read and agree to comply with the Regulations For a Recreational Fire*

    1. I Agree
23. The proposed fire pit will be*
    -- Select One --In the groundPortable
24. This Recreational Fire Permit application is*
    -- Select One --A new applicationA renewal application
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field