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2. Applicant's Name*
3. Email Address
5. If Corporation - Name of Manager or Agent
7. Address*
9. City
10. State
11. Zip Code
13. Phone Number
14. Fax Number
16. Purpose of Permit*
18. Address of Premises *
20. The undersigned agrees to comply with all applicable codes and regulations. Permittee, by acceptance of any permit, agrees to indemnify and hold harmless the City of Canandaigua from any and all claims of personal injury and property damage arising from the operations of the permitee.
22. Applicant Signature
24. Date*
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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