PYROTECHNICS PERMIT APPLICATION Download PDF Application 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: 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. 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. Attach a diagram of the grounds at which the display will be conducted. The diagram must: a. Be drawn to scale or with dimensions included; b. Show the point at which the fireworks/pyrotechnic special effects are to be discharged; c. Show the location of ground pieces; d. Show the location of all buildings, highways, streets, communication lines, and other possible overhead obstructions; e. Show the lines behind which the audience will be restrained. Applicant must supply names and ages of all assistants that will be participating in the display. 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. Application must include a $75 non-refundable fee. 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 INFORATIONName 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Name of Authorized Agent of Applicant or Sponsoring Organization Telephone Number of Authorized AgentDISPLAY DETAILSDate 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 DisplayPYROTECHNIC 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 NumberSIGNATURE & 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 OrganizationDate MM slash DD slash YYYY FOR DEPARTMENT USEDate 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 INFORMATIONPermit Issued to (Name of Applicant or Sponsoring Organization) Date of Display MM slash DD slash YYYY Permit NumberPermit 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:APPROVALSSignatureTitle Date MM slash DD slash YYYY SignatureTitle Date MM slash DD slash YYYY CAPTCHAzero x 1 = ? NameThis field is for validation purposes and should be left unchanged.