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2301 N. Cameron St. | Harrisburg, Pa 17110-9406 | Suite G-4 | 717.787.9089
NEW Consumer Fireworks Facility License Application Checklist
This document is a checklist to help make sure that your application to the Pennsylvania
Department of Agriculture (“Department”) for a Consumer Fireworks Facility License is complete.
It should be reviewed, signed and returned to the Department along with your complete
application.
The person submitting the application to the Department for the Applicant should check or
initial each box, where indicated, to confirm that the indicated step has been taken to complete
the Application.
The Department will schedule a facility for inspection once it receives a complete application.
An incomplete application will be returned to the Applicant by the Department without further
action by the Department.
Checklist:
⃣ The Applicant has read, understood and completed the Consumer Fireworks Facility License
Application. The Application has been fully-executed by the Applicant, with all blanks filled-in.
⃣ The Applicant understands an incomplete application will be returned to the Applicant by the
Department without further action by the Department.
⃣ A
certified check, money order or cashier’s check,
made payable to the “Commonwealth of
Pennsylvania” in the full amount called for in the Application, is enclosed with the Application.
⃣ All four of the attachments called for in the Application are included with the Application.
These include:
Attachment “1” – An occupancy permit or similar proof that the building in which the
Facility is located is compliant with the Pennsylvania Construction Code Act.
Attachment “2” – Proof of Required Insurance Coverage, as described in the
Application.
Attachment “3” – A completed “Employee Training Record” form.
Attachment “4” – Proof of a monitored burglar and fire alarm system.
There are no misrepresentations or false statements in this document. All representations in
this application are made subject to the criminal penalties for unsworn falsification to authorities
(Pennsylvania Crimes Code, 18 Pa. C.S.A. § 4904).
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Printed Name Signature Date
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signature
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