Form Center

2. Identifying Information
4. Permit ID*

   Input your permit ID. This can be found in the center of your permit and is typically 3-4 letters followed by 3-4 numbers. For example, a food service establishment permit would typically by FDS#### and a dumpster permit would be DUMP####.

5. Name of authorized individual making changes*
7. Business/location name*
8. Business/location address*
12. Enter new contact information below
14. Primary contact name
16. Mailing Address
18. City
19. State
20. Zip Code
22. Home Phone number
23. Work Phone number
25. E-mail address
Leave This Blank:


27. Submit

* indicates a required field