Pyrotechnics Permit

This form is available in electronic format at www.tooelefire.org
In order for this application to be considered, it must include the following requirements & required attachments:
1. This application must be completed and returned to the Tooele City Fire Department at least 21 calendar days (3 weeks) prior to the date of display.
2. Applicant must supply proof of a bond or certificate of insurance as outlined in Tooele City Code 3-4-13 for firework sales, stands, and discharge of fireworks.
3. Attach a diagram of the grounds at which the display will be conducted. The diagram must:
4. Applicant must supply names and ages of all assistants that will be participating in the display.
5. Applicant must be in line with the 2009 International Fire Code, Chapter 33, and any other chapter listing within the Code that applies to the use and sale of fireworks.
6. Application must include a $75 non-refundable fee.
7. Application must include a deposit, certificate of deposit, or security bond made payable to Tooele City in the amount of $250 as outlined in Tooele City Code Fireworks Chapter 3-4-13(12).
SPONSOR AND AGENT INFORATION
Name of Applicant or Sponsoring Organization
Date of Application
MM slash DD slash YYYY
Address of Applicant or Sponsoring Organization
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name of Authorized Agent of Applicant or Sponsoring Organization
Telephone Number of Authorized Agent
DISPLAY DETAILS
Date of Display
MM slash DD slash YYYY
Time of Display
Location of Display
Manner and Place of Storage of Fireworks/Pyrotechnic Special Effects Prior to Display
PYROTECHNIC OPERATOR
Utah State law requires that this display be conducted under the direct supervision of a pyrotechnic operator certified by the state fire marshal.
Name of Supervising Operator
Operator’s Certificate Number
SIGNATURE & AGREEMENT
I understand and agree to comply with all provisions of this application and the requirements of the issuing authority, and will ensure that the fireworks/pyrotechnic special effects are discharged in a manner that will not endanger persons or property or constitute a nuisance
Signature of Authorized Agent of Applicant or Sponsoring Organization
Date
MM slash DD slash YYYY
FOR DEPARTMENT USE
Date Received By Department
MM slash DD slash YYYY
Received By
$75 Fee Collected?
- Yes
- No
Deposit, certificate of deposit, or security bond made payable to Tooele City in the amount of $250 Collected?
- Yes
- No
PERMIT INFORMATION
Permit Issued to (Name of Applicant or Sponsoring Organization)
Date of Display
MM slash DD slash YYYY
Permit Number
Permit Issue Date
MM slash DD slash YYYY
The storage and discharge of the listed fireworks on the date and at the location shown on this application is hereby approved, subject to the following conditions, if any:
APPROVALS
Signature
Title
Date
MM slash DD slash YYYY
Signature
Title
Date
MM slash DD slash YYYY
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Email
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This form is available in electronic format at www.tooelefire.org

SPONSOR AND AGENT INFORATION

DISPLAY DETAILS

PYROTECHNIC OPERATOR

SIGNATURE & AGREEMENT

FOR DEPARTMENT USE

PERMIT INFORMATION

APPROVALS