APPLICATION FOR PERMIT SHALL BE MADE IN WRITING AT LEAST 15 DAYS IN ADVANCE
OF THE DATE OF THE DISPLAY AS PER FLORIDA STATUTE 791.02

Date:

Address of Display:

Display Date:

Time:

Duration:

Name of Sponsoring Organization:

Organzation Phone#:

Fireworks or Pyrotechnic Company Name:

Address:

Company Representative Name / Phone#:

Type of Display (Inside or Outside):

Number of Shells or Devices:

Size & Description of Shells or Devices:

MINIMUM CLEARANCE TO BLDGS, ROADS, PARKING AREAS OR SPECATOR VIEWING / SEATING AREA, SHALL BE
INDICATED ON SITE PLAN DIAGRAM.

Number of Personnel to be Used for Display:

Crowd Control:

ATTACH COPY OF B.A.T.F. LICENSE TO PERMIT APPLICATION AND INCLUDE CHECK IN THE SUM OF $150.00 PAYABLE TO THE CITY OF DAYTONA BEACH

Attach File (if applicable):

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GENERAL INFORMATION: The operation of any fireworks or pyrotechnic display shall be in accordance with NFPA 1123 or NFPA 1126. Wind conditions must be monitored by the operator. Monitors whose sole duty shall be the enforcement of crowd control shall be located around the display area by the sponsor.

INSURANCE: For standard fireworks display, the permittee must furnish a bond or certificate of insurance with limits of liability of no less than $250,000 per person and $500,000 per occurrence for bodily injury and $100,000 per occurrence for property damage or a combined single limit of $500,000 for bodily injury and property damage. For ultra hazardous fireworks display – the permittee must furnish a bond certificate of insurance with limits of liability of no less than $500,000 per person and $2,000,000 per occurrence for bodily injury and $500,000 per occurrence for property damage or a combined single limit of $2,000,000 for bodily injury and property damage. In addition; the permittee is to include the City as an additional insured under this policy.

SITE PLAN:The applicant must submit with this application a diagram of the display area showing the discharge area, location of all
buildings and roadways, the audience restraint lines, the location of any trees, telephone and / or power lines or other overhead obstructions, spectator/viewing /seating area and description of display area for indoor discharge.

I Have Read the Document and Understand All Provisions: *

Yes