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  1. REQUEST FOR FIREWORK DISPLAY APPLICATION/PERMIT

    In accordance to NFPA 1123/1126- Penal Law 405 & 270

  2. Display Company:
  3. Emergency Contact
  4. Operator
  5. Assistant
  6. Display Information
  7. Display Location
  8. Storage prior to display
    • Application for Operating Permit
    • Site Plan for display and fallout area
    • Certificate of Worker’s Compensation Insurance
    • Certificate of Insurance Coverage
    • Copy of Federal License/Permit (FEL)
    • Copy of State of New York Department of Labor-License to Deal in or Manufacture Explosives
    • Copy of Pyrotechnician Licenses
    • Display Content of Show:
  9. I attest that the information contained in this permit application is accurate, true and complete to the best of my knowledge, and I understand that false statements made in this permit application are subject of applicable versions of the 

    NYS PENAL LAW. 

  10. Leave This Blank:

  11. This field is not part of the form submission.