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APPLICATION FOR PUBLIC DISPLAY FIRE WORKS APPLICANT CHECK ONE: INDIVIDUAL PARTNERSHIP CORPORATION OTHER Idaho State Wholesale and Import License Number: Please attach a copy. Name and primary address of applicant: List the names of all partners or corporate officers and primary place of business, if applicable. Name and specific street address where fireworks will be stored: Name of insurance carrier (please attach valid certificate of public liability and property/casualty insurance providing coverage of $1,000,000 for personal injury and property damage within time for the public display of fireworks): APPLICANT CHECK ONE: Application is for public display of non-aerial fireworks. OR Fireworks other than non-aerial common fireworks. “Non-aerial common fireworks” means any fireworks such as ground spinners, fountains, sparklers, smoke devices or snakes designed to remain on or near the ground and not to travel outside a fifteen (15) foot diameter circle or emit sparks or other burning material which land outside a twenty (20) foot diameter circle or above a height of twenty (20) feet. Non-aerial common fireworks do not include firecrackers, jumping jacks, or similar products. SIGNATURE OF APPLICANT: 1. Please remit $125.00 (non-refundable application fee) along with this form to: City of Jerome 152 East Avenue A Jerome, ID 83338 2. This permit shall be displayed in public view at the location listed on the permit. PERMIT This application has been reviewed by the Fire Chief on the day of , 20 . The application is found to be in compliance with the provisions of 8.24.030 of the Jerome Municipal Code and Idaho Code 39-2601, et seg. Fire Chief Application for the permit of for public display of (name) on at has been approved by the (non-aerial fireworks or other fireworks) (date) (time) (place) Jerome City Council on the day of , 20 . City Clerk