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CITY OF JEROME 152 E AVENUE A JEROME, ID 83338 (208)324-8189 EXT. 105 APPLICATION FOR TEMPORARY RETAIL SALE OF NON-AERIAL COMMON FIRE WORKS APPLICANT CHECK ONE: INDIVIDUAL PARTNERSHIP CORPORATION OTHER Idaho State Wholesale and Import License Number: Idaho State Sales Tax Permit Number: Please attach copies. Name and Address of applicant: Location where the applicant requests permission to sell safe and sane fireworks: Maximum amount of safe and sane fireworks to be stored specified in pounds: Where the fireworks will be stored: List the primary purpose for which the applicant exists: When and where the applicant business was organized and established, or, if a natural person, the applicant’s age: List the names and addresses of the officers, trustees and/or directors, if any, of the applicant and primary place of business, if applicable: ---PAGE BREAK--- Name of insurance carrier: Please attach copy of a policy or certified copy thereof, of public liability insurance, including both accident and occurrence coverage in an amount of at least $500,000 per occurrence. DATE: SIGNATURE OF APPLICANT: 1. Please remit $50.00 (application and inspection fee) along with this form to: City of Jerome Attention: City Clerk 152 East Ave. A, Jerome, ID 83338 2. Authorized dates for sales: Beginning midnight June 23rd End midnight July 5th Beginning midnight December 26th Ending midnight January 1st 3. This permit shall be displayed in public view at the location listed on the permit. 4. A copy of the City of Jerome Fireworks Ordinance including rules and regulations for fireworks stands will be provided to each applicant upon receipt of an application. 5. Should Permittee choose to sell under this permit in December/January a new $25.00 inspection fee will be charged to have fire department personnel inspect the fireworks stand. PERMIT A PERMIT FOR TEMPORARY RETAIL SALE OF NON-AERIAL COMMON FIRE WORKS is hereby issued this day of , 20 . CITY CLERK NOTE: If the application is denied, applicant will be informed in writing of the standards and reasons for denial.