Fireworks Exhibition Permit Application

Submit application 30 days before event to

Display Sponsor

SPONSORING ORGANIZATION*

NAME*

POSITION*

ADDRESS*

PHONE NUMBER*

Phone

EMAIL*

FIREWORKS DISPLAY DATE

DATE OF DISPLAY*

Start Time*

End Time*

LOCATION*

Will there be aerial display shells?

Yes, there will be aerial display shells

No, there will NOT be aerial display shells

Proximate Audience Display

Yes

LARGEST SHELL SIZE*

NFPA 1123

DISTANCE TO NEAREST HAZARD*

PARTY RESPONSIBLE FOR SECURING DISPLAY SITES*

PYROTECHNIC DISPLAY COMPANY INFO

NAME*

ADDRESS*

PHONE*

Phone

EMAIL*

INSURANCE COMPANY INFO

NAME*

ADDRESS*

PHONE NUMBER*

Phone

PYROTECHNICIAN / OPERATOR INFO

NAME(S)*

ADDRESS*

CELL PHONE NUMBER*

Phone

ADDITIONAL INFO

ATTACH COPY OF FIREWORKS PERMIT FROM PROBATE COURT. ATTACH COPY OF $1 MILLION CERTIFICATE OF INSURANCE. ATTACH A COPY OF THE OPERATORS PHOTO IDENTIFICATION. ATTACH COPY OF PYROTECHNICIAN’S LICENSE (CLOSE PROXIMATE) AND PYROTECHNIC TRAINING CERTIFICATE. ATTACH LIST AND DATES OF PREVIOUS DISPLAYS COVERING THE LAST YEAR. (PYROTECHNICIAN’S RESUME) ATTACH A LIST OF THE NUMBER OF SHELLS AND THEIR RESPECTIVE SIZES.

Check here if you attached a copy of the fireworks permit from Probat Court*

Check here if you attached a copy of $1 Million Certificate of Insurance*

Check here if you attached a copy of the Operators Photo Identification*

Check here if you attached a copy the Pyrotechnician's License (Close Proximate) and Pyrotechnic Training Certificate*

Check here if you attached the dates of previous displays covering the past year (Pyrotechnician's Resume)*

Check here if you attached a list of the number of shells and their respective sizes*

Upload all documents here*

Drag and drop files here or

Special Note

SHELLS OVER FOUR INCHES IN DIAMETER AND SALUTE SHELLS ARE PROHIBITED AT GRAYSON STADIUM.

Display Cut Off Time (Concluded By)

GRAYSON STADIUM 9:30 PM IF SCHOOL IS NEXT DAY / 10:30 PM OTHERWISE WATERFRONT 10:00 PM EXCEPT NEW YEARS EVE/NEW YEARS DAY

Please Enter your name below*

I HERBY AGREE TO HOLD THE CITY OF SAVANNAH HARMLESS FOR ANY AND ALL DAMAGE TO PERSONS AND PROPERTY RESULTING FROM THE USE OF FIREWORKS BY THE PARTY IN CHARGE OF THIS EXHIBITION OR HIS ASSISTANTS. THE EXHIBITION SHALL BE EXECUTED IN STRICT COMPLIANCE WITH NFPA 1123, 1124, 1126, AND CHAPTER 120-3-22 RULES AND REGULATIONS OF THE SAFETY FIRE COMMISSIONER AS ADOPTED BY THE CITY OF SAVANNAH, AS WELL AS ALL STATE AND FEDERAL REQUIREMENTS. I FURTHER CERTIFY THAT ALL INFORMATION CONTAINED IN THE APPLICATION IS TRUE.

* Check the "Send me a copy of my responses" box below *

This will email you a copy of your permit application. Then you can print off the permit application and attach to your

Check here if you checked the "Send me a copy of my responses" box below*

Send me a copy of my responses

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Display Sponsor

FIREWORKS DISPLAY DATE

Will there be aerial display shells?

Proximate Audience Display

PYROTECHNIC DISPLAY COMPANY INFO

INSURANCE COMPANY INFO

PYROTECHNICIAN / OPERATOR INFO

ADDITIONAL INFO

Special Note

Display Cut Off Time (Concluded By)

*** Check the "Send me a copy of my responses" box below ***

* Check the "Send me a copy of my responses" box below *