Application for Detonation of Fireworks

First

Last

Address

City/Town

State/Province

ZIP/Postal Code

Date:

Event Type:

Hall Area:

(a) Must apply 10 days prior to the fireworks event.
(b) Permit holder must be 19 years or older.
(c) A Fireworks Safety Plan will be required.
(d) A letter from the homeowner will be required giving permission to detonate fireworks
(e) Proof of comprehensive general liability insurance with a minimum of $5,000,000.00 per occurence.

Date & Time of Event:

Description of Fireworks:

Attendance Estimate:

Emergency Procedures:

Fireworks Storage Area Description:

The Fireworks Safety Plan is a site plan that will indicate the direction of the proposed discharge; all separation distances form any significant ground features, structures, overhead obstructions, parking areas, spectator viewing areas and proposed fall out areas.

Applicant's Signature

Sign above

All applications will be accompanied with a $200.00 fee. The Fire Department will complete a site inspection prior to permit approval

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