Sale of Fireworks Permit Application

Permit for the Sale of Fireworks Application
Work or activity requiring a permit shall not commence until such work or activity has been inspected and authorized with a valid permit. Violation of this condition may result in additional permit or inspection fees.
GENERAL INFORMATION
Business:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person:*
Phone No:*
Email Address:*
example@example.com
Will the Location be different then the address above?*

YesNo
LOCATION OF PERMITTED ACTIVITY
Business Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mount Pleasan City Ordinance 2018-1018 Section 7-604

$1,000.00 non-refundable fee for each location and sale period.
State of TN Fireworks Seasonal Retailer Permit:*

Cancelof
Certificate of Insurance:*

Cancelof
Site Plan:*

Cancelof
Lease Agreement for Site:*

Cancelof
Certificate of Flame Resistance:*

Cancelof
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Specific Permit Conditions:
Application Disposition

ApprovedDenied
Denied Reason:
Reason for Denial:
Reviewed / Inspected By:
Date:

MonthDayYear
Date
Reviewed/Inspected By:
Date:

MonthDayYear
Date
Should be Empty:

Permit for the Sale of Fireworks Application