Fillable Fireworksspecialeffectsapplication LAKE HAVASU CITY FIRE DEPARTMENT PERMIT APPLICATION

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Fireworksspecialeffectsapplication LAKE HAVASU CITY FIRE DEPARTMENT PERMIT APPLICATION

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LAKE HAVASU CITY FIRE DEPARTMENT
Fire Prevention Bureau
2330 McCulloch Blvd. N.
Lake Havasu City, AZ 86403
(928) 855-1141 www.lhcaz.gov
FD-220 Updated/CA 1-01-2020
Fireworks/Special Effects Application
Permit process and time frame: In order to process your application or request for service within 72 hours from the date of submittal,
all requested information and attachments must be provided. Contact Fire Administration with any questions at (928) 855-1141 or email
lhcfire@lhcaz.gov.
Display director:
Phone:
Sponsor:
Phone:
Contact person:
Phone:
Display location:
Display date:
Time:
Provide the following items with this application:
Make checks payable to
Lake Havasu City.
I reviewed the above information and am authorized to execute this application. This permit may be revoked at any time by a
representative of the Lake Havasu City Fire Department when conditions put public safety at risk.
Signature of Applicant Date
Clarification of Interpretation: A person may request the City to clarify its interpretation or application of a statute, ordinance, code,
or policy affecting the procurement of this license pursuant to A.R.S. § 9-839.
TO BE COMPLETED BY FIRE PREVENTION BUREAU
Approved by:
Date:
Comments:
Permit #:
Fee:
Cash Check Credit Card
Issued by:
Date issued:
Inspection scheduled: Yes
No
Date for inspection:
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Fireworksspecialeffectsapplication LAKE HAVASU CITY FIRE DEPARTMENT PERMIT APPLICATION

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Completed 13 July 2020

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