Commercial Fireworks Display Permit Application

Permit Information

Display information

Date of Display (required) Date of Display

Alternate Weather Date of Display (required) Alternate weather date of display

Time of display (required) Time of Display

Alternate Weather Time of Display (required) Alternate weather time of display

Location Information

Address of Display (required) Address of display

City of Display (required) City of display

Location on the property where the display will occur (required) Location on property

Owner Information

Property Owner Name (required) Owner name

Owner Address (required) Owner address

Owner City (required) Owner city

Owner ZIP Code (required) Owner zip code

Owner Phone number (required) Owner phone number

Property Owner Contact (must be a person)

Contact Name (required) Contact name

Contact Address (required) Contact address

Contact City (required) Contact city

Contact Home phone (required) Contact home phone

Contact Cell (required) Contact cell

Has written permission of the property owner been obtained (required)

Yes

Owner Permission obtained

Operator Information

Operator Name (required) Operator name

Operator Address (required) Operator address

Operator City (required) Operator city

Operator ZIP code (required) Operator zip code

Operator Home Phone (required) Operator home phone

Operator Cell Phone (required) Operator cell phone

Operator License # (required) Operator License Number

Issued Date (required) Issued date

Expiration Date (required) Expiration date

Verification

I certify the above information is true and correct to the best of my knowledge and belief. I understand that any incorrect information submitted on this application will give the Sedgwick County Fire District #1 authorization to deny my permit application and retain the application fee. I also certify that I have attached all required information. I understand that only completed applications will be accepted. I understand that all documentation including proper evidence of the required insurance coverage, permit fee, and this application must be received by the fire district no less than 10 days prior to the date of the display as stated above. Permits issued under the 10-day requirement shall be charged an additional $25 per day under the 10-day requirement. (required)

FIREWORKS DISPLAYS SHALL BE CONDUCTED IN ACCORDANCE WITH NFPA 1123 and 1127 AND SHALL CONFORM TO THE REQUIREMENTS AS SET FORTH ON PERMIT. The permit, if issued, must be posted at the display site and surrendered upon request to the representative of the Sedgwick County Fire District #1. I further understand that no one is permitted to discharge any type or form of common fireworks at the site. The permit will not be transferable to another operator. Violation of these requirements may cause my permit privileges to be forfeited and future permits to be denied. (required)

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