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2. Restaurant Name*
4. Restaurant Address*
6. Phone Number*
7. Fax Number
9. Email Address*
11. Propane Heaters*
    Please indicate how many propane heaters you would like. Please include information about # of tables the heaters will support.
13. Existing Propane Heaters?*
    Please indicate if you were able to order or obtain existing propane heaters.
15. Lowell Fire Department Permit*

    Please indicate whether or not you have applied for a propane heater permit from LFD.

    1. Yes
    2. No
16. Outdoor Seating*

    1. Yes
    2. No

    Please indicate if you will be providing outdoor seating for patrons between 10/31 - 12/1.
18. Additional Comments
20. Streatery

    1. 11/2/220
    2. 12/1/2020

    If you have a streatery, please indicate the date you want DPW to REMOVE the barriers. This is an approximate date. We cannot guarantee removal on this exact date.
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field