2. Application Date*
   Application Date
4. Applicant Name*
5. Contact Number*
7. Email Address*
9. Address*
11. City*
12. State*
13. Zip*
15. Property Owner*
16. Property Owner's Address*
18. City*
19. State*
20. Zip*
22. Date(s) fireworks will be on sale or display*
24. Permit Type*

    1. Vendor: Sale of Class "C" Fireworks
    2. Display of Fireworks: Select Private or Public
28. Display Fireworks
30. Is Display Public or Private?
    -- Select One --PublicPrivate
32. Display Fireworks: Submit copy of insurance

    Please provide proof of a corporate surety bond or public liability insurance policy

33. Display Fireworks: Submit list of fireworks to be discharged
34. Display Fireworks: Submit Site Map

    Diagram should include: (1) the point at which the fireworks are to be positioned and fired (2) the fallout radius for each device used (3) the lines behind which the spectators will be restrained

36. Certified Pyrotechnician in Charge

    Name

37. Pyrotechnician Certification Number
38. Certification Expiration Date
42. Vendor Sales
44. Inside Sales?

    1. Yes
    2. No
45. Outside Sales?

    1. Yes
    2. No
47. Attach Inside Sales Diagram
    Show location of: (1) Sales display (2) EXITS (3) Distance (in feet) from fireworks sales display to exits (4) Location of fire extinguishers
48. Attach Outside Sales Diagram
    Show location of: (1) Sales stand or tent (2) EXITS (3) Distances from stand or tent to streets, parking entrances, buildings or combustible structures, or flammable liquids dispensers (See Fireworks Permit Information for minimum required distances)
50. Inside Sales must submit copy of most recent inspections of fire alarm and sprinkler systems
51. Outside Sales: Will a Tent be Used?

    1. Yes
    2. No

    If Yes, please submit a **Tent Permit Application** and include Certificate of Flame Resistance for tent material
54. **Tent Permit Application**
    Tent Permit Application

    Click here to be taken to the Tent Permit Application form
58. Additional Information
60. Attach Current Business License from the City of Waynesboro
61. Attach Certificate of Liability Insurance
63. Attach Inventory List
    Complete inventory list to include PRODUCT NAME and PRODUCT ITEM NUMBER
64. Attach Supplier Contact Information*
66. Please submit a copy of the property owner's consent*

    Must be on company letterhead and have owner's signature

67. Notes
    Must review and follow Fireworks Permit Information.
68. Fireworks Permit Information
    Permit Information
70. Acknowledgement*

    1. I hereby agree

    I have read and understand the Fireworks Permit Information. All information is complete and accurate to the best of my knowledge, and I agree to comply fully with all requirements governed by the City of Waynesboro Fire Department. Failure to provide complete and accurate information shall be just cause for revocation. Applicant is responsible for scheduling required inspection(s) prior to the issuance of permit.
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72. Submit Submit and Print

* indicates a required field