Kearney Fireworks Display Permit

DOWNLOAD Fireworks Display Permit

"*" indicates required fields

Date*

County*

State*

Person Responsible for Display (Fireworks Purchaser)*

Person Responsible for Display Address*

Street Address Address Line 2 City State ZIP / Postal Code

I hereby acknowledge that the person stated above has approval to shoot a fireworks display on (insert date)*

Located at:*

Street Address Address Line 2 City State ZIP / Postal Code

Property Owners Name*

The responsible person must provide a copy of the ATF permit to receive this permit. The responsible party must also abide by NFPA 1123 Guidelines for the proper discharging clearances and Section 5608 of the 2012 International Fire Code for Fireworks Display.

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Office Use

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Approved By Signature

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Date

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Printed Name:

First Name Last Name

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Expiration Date

Phone

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