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Application for Outdoor Public Display of Fireworks Application submission deadline is a minimum of 15 days in advance of the event date. Please note: • Information regarding the fireworks display, including the date and time, must be advertised at least once in the local newspaper. • The Fire Marshal has the authority to revoke the permit based on fluctuating or extreme fire conditions on the day of the event. 1. Individual, group, or organization sponsoring the outdoor fireworks display: Name: Address: City / State: Phone: Email: 2. Fireworks supplier: Name: Address: City / State: Phone: Email: 3. Financial Responsibility – Please attach proof of insurance naming City of Whitefish as an additional insured on the $1,000,000 General Liability Insurance policy. Provider: Phone: Does policy list City of Whitefish as an additional insured party? Yes No Permit will not be approved unless the City of Whitefish is listed as an additional insured party. 4. Fireworks Date (mm/dd/yy): Time: Optional Alternate Rain Date: Time: 5. Length of Display: 6. Address of Discharge: 7. Pyrotechnician Name: Contact Phone During Event: ---PAGE BREAK--- 8. Submit a site plan to the Fire Marshal of the proposed display venue, including the temporary storage site, the parking and spectator viewing areas, the fireworks discharge point, location of structures, roads, streets and alleys within a one thousand (1,000) yard radius, overhead obstructions, and other hazards. 9. List the number, type, and size of fireworks to be discharged. Sonic booms are not allowed. Number Type Size Please use a separate document if additional space is needed. 10. Organization should document efforts to obtain low or no perchlorate fireworks. As a condition of the city granting a permit, the permittee and operator shall be required to replace, subject to availability, a portion of the fireworks to be used in the display with low or no perchlorate fireworks in accordance with the following schedule: I verify that the above information is accurate. I understand that I am responsible to have fire suppression tools on site. I will properly dispose of all firework waste, including duds. I am aware that false statements may result in a revocation of my permit. Signature Date Fire Department Approval Signature Date 2021 10% 2022 20% 2023 30% 2024 40% 2025 50%