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Fireworks Permit Application

  1. Permit Type*
  2. Display Fireworks
  3. Please provide proof of a corporate surety bond or public liability insurance policy

  4. 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

  5. Name

  6. Vendor Sales
  7. Inside Sales?
  8. Outside Sales?
  9. Show location of: (1) Sales display (2) EXITS (3) Distance (in feet) from fireworks sales display to exits (4) Location of fire extinguishers
  10. 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)
  11. Outside Sales: Will a Tent be Used?
    If Yes, please submit a **Tent Permit Application** and include Certificate of Flame Resistance for tent material
  12. Additional Information
  13. Complete inventory list to include PRODUCT NAME and PRODUCT ITEM NUMBER
  14. Must be on company letterhead and have owner's signature

  15. Notes
    Must review and follow Fireworks Permit Information.
  16. Acknowledgement*
    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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