HomeMy WebLinkAbout1 -Fireworks Sales and Display ApplicationDate Received: __________________
Received By: ____________________
Permit #: _______________________
City of Lake Elmo
3880 Laverne Ave N
Lake Elmo, MN 55042
Administration: 651-747-3904, Fire Department 651-747-3930
FIREWORKS SALES AND DISPLAYS
Fireworks sales and display permits shall be submitted by the contractor or sales company only.
Property Information:
Display Address: _____________________________________________________________________________________________
Property Owner: ____________________________________________________________ Phone: ___________________________
Address: ____________________________________________________________________________________________________
Email Address:_______________________________________________________________________________________________
Applicant Information (Must be a Licensed Contractor):
Company: __________________________________________________________________________________________________
Address: ____________________________________________________________________________________________________
City: ________________________________ State: __________ Zip: ______________ Phone: _______________________________
License No: _________________________Expiration Date: _____________ Phone: _______________________________________
Email Address: ___________________________________________________ Contact Name _______________________________
Type of Permit:
☐ Annual Retail Consumer Fireworks – Stand Alone Fireworks Sales
☐ Annual Retail Consumer Fireworks – All Other Retailers
☐ Fireworks/Pyrotechnics Display. Valuation of Work $_______________________ Date of Display: __________________________
☐ Other (Describe): __________________________________________________________________________________________
Description of Display or Sales:
___________________________________________________________________________________________________________
1/3/2024 10:04 AM
Fee Schedule Worksheet:
*** All permit and plan review fees must be paid in full at the time of application. ***
Permit Type Fee Quantity Subtotal
Annual Retail – Stand Alone $350.00 per location $
Annual Retail - Other $100.00 per location $
Total: $
Permit Type Fee Quantity Subtotal
Fireworks/Pyro Display $150.00 per event $
Plan Review 2% of work valuation $ of Valuation x .02 =
plan review fee $
Standby Firefighters Actual Wage per hour TBD – consult w/
Fire Department $
Total: $
Applicant Name (Please Print) ___________________________________________________________________________________
Applicant Signature: ______________________________________________________Date:________________________________
This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction work is suspended or
abandoned for a period of 180 days at any time after work has commenced. I hereby certify that I have read and examined this application and know
the same to be true and correct. All provisions of the laws and ordinances governing this type of work will be complied with whether specified herein
or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating
construction or the performance of construction.
The need for Standby Firefighters will be addresses and based on the size and location of the display.
Required Plan Submittals: shall include the number, type, and size of discharge fireworks. Fallout radius for each pyrotechnic device.
Diagram of location of the launch site, the location of buildings, overhead obstructions, and the like. Clearances from spectators,
combustibles, and crowd control measures.
Any and all fireworks display permit applications shall include proof of certification as a pyrotechnic operator by the State Fire Marshal.
Inspections: scheduling inspections is the responsibility of the contractor. Periodically, a fire code official may choose to spot check
projects, however, these spot checks do not replace scheduled inspections as required on the permit document.
City Use Only
Application Reviewed by: _________________________________________________________Date:_________________________________