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2. Name of Business / Applicant Entity*
4. Contact Name*
5. Title
7. Email Address*
8. Phone Number*
10. Business Address*
12. City*
13. State*
14. ZIP Code*
16. What Type of Equipment Does Your Business Need?*

    1. Space Heater(s)
    2. Canopy / Wind Screen
    3. Fire pit(s)
    4. Outdoor seating fencing / platform
    5. Other
17. If "Other," please specify.
19. Please explain how you will use the requested equipment.*
21. Do you have an existing outdoor seating permit with the City of Glenwood Springs?*

    1. Yes
    2. No
    3. N/A
22. Amendments and Approvals
    Additional amendments or approvals may be required for equipment installation, including but not limited to, fire inspections and outdoor dining permit reviews.
24. Certification*

    I understand that, if selected to receive equipment, my business will be responsible for appropriate care and maintenance. While seasonal wear and tear is to be expected, any additional damage may require replacement or reimbursement to the City of Glenwood Springs. An agreement form will be provided to those selected to receive equipment.

    1. I agree.
Leave This Blank:


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