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Modesto Fire Department FIRE PREVENTION DIVISION 409 12th Street Modesto, California 95354 Tel: (209) 571-5553 Fax: (209) 544-1652 AMUSEMENT BUILDING PERMIT APPLICATION Applicant’s Name and Phone Number: Applicant’s Driver’s License Number and State: Applicant’s Permanent Address (not PO Box): Address of Event: Owner of Property/Building and Phone Number: If a permanent building, what is the designed use of the structure being used? (e.g. warehouse, factory, store, auditorium, church, etc.): Date(s) and Hour(s) of Operation: Briefly summarize activities in the Amusement Building and in the immediate surrounding area. • See Amusement Building Guidelines for more information. • The complete permit application package shall be submitted at least 6 weekdays (excluding holidays) before the site inspection date entered below. • A site inspection is required. Specify day of the week, date, and time site will be ready for inspection: / day of the week date time • An afterhours inspection fee will be charged if an inspection is needed outside of normal business hours (normal business hours: weekdays 8:00am to 5:00pm except holidays). • Provide a drawn-to-scale site diagram and a floor plan showing all details called for in the Amusement Building Guidelines. • In a typed narrative, address those individual requirements detailed in the Amusement Building Guidelines that are not included on the site diagram or floor plan. In other words, if you feel some requirement does not apply to you explain why “up front” in the narrative so that we do not have to call you to inquire (which would delay your permit). For example, if you are not going to use a generator, or the event will not have a ceiling (i.e. it is open to the sky so does not require fire sprinklers or smoke alarms), say so in the narrative. In your narrative, refer to the letter of the paragraph of the Amusement Building Guidelines being addressed (e.g. A. , B. , C. , etc.). Applicant’s Signature: Date: In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website at Disabilities-Act-ADA revised 6/23/2020 SIGN