Fillable Fire Works Display Application (Skagit County Government)

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Fire Works Display Application (Skagit County Government)

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Fireworks Display Permit updated 3/30/2018 page 1 of 1
Fireworks Display Permit Application
Planning & Development Services · 1800 Continental Place · Mount Vernon WA 98273
voice 360-416-1320 · inspections 360-416-1330 · www.skagitcounty.net/firemarshal
Part 1 Project/Site
Property Owner
Parcel #
Site Address
City
Zip
Part 2 Contact Information
Applicant
Name
Organization
Address
City
Phone
E-mail
Pyrotechnician
Name
Firm Name
Address
City
Phone
E-mail
License #
Part 3 Attachments
Please attach all of the following:
Copy of current Washington State Pyrotechnicians License (obtain from Washington State Fire Marshal at 360-753-0400)
A list of the types of fireworks to be displayed, including (1) quantity and (2) size for each type.
Photo or diagram of the rack arrangement for display. Racks or supports must ensure stability of fireworks.
A site plan that shows all of the following:
adjacent buildings
parking
streets/roads
distances from proposed display
direction of firing
proposed crowd locations
fallout zones
Proof of insurance (required by RCW 70.77.295) in the amounts of:
bodily injury liability of at least $50,000 per person, and at least $1 million per person per event
property damage liability of at least $25,000 per event
Part 4 Signature
Applicant signature below attests the information above and attached is accurate. Property owner signature conveys consent to use
the property for the described fireworks display.
Applicant
Property Owner
Permit #:
Received by:
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Fire Works Display Application (Skagit County Government)

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Completed 24 July 2020

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