PLEASE PRINT
LOCATION OF DISPLAY:
State Zip Code
Certificate of Insurance or Bond Attached: (Initial )
The exact location of planned outdoor fireworks display. Attach a site map showing discharge
area and fallout area. This is to include the point at which the fireworks are to be discharged, the location
of all buildings, highways and overhead obstructions and the required setbacks for restraining the audience.
Attached Site Map:
(Initial)
Attached Certification of Person Shooting:
(Initial)
Event has been Approved by the Lee County Board of Commissioners:
(Initial)
The approximate number and kinds of fireworks to be discharged:
* All Applications and Supporting Documentation must be submitted digitally.
* A Permit Fee of $100.00 is Required (Check or Money Order)
Fire Code Official's Signature: Dat e
Office of Lee County Fire Marshal
PO Box 1154, 204 West Courtland Drive
Sanford, North Carolina 27331
Phone (919) 718-4670 FAX: (919) 718-4630
PERSON CERTIFIED TO SHOOT DISPLAY:
Name and address of the individual, group or organization sponsoring the outdoor display:
The Fire Marshal's Office shall make an inspection of the proposed site of discharge and fallout areas to
The manner and place of storage of such fireworks prior to the delivery to the outdoor fireworks display
site:
Fireplans@leecountync.gov
determine if the provisions of NFPA 1124 and the Volume V. N.C. Fire Prevention Code have been met.
FIREWORKS PERMIT APPLICATION
THIS SECTION TO BE COMPLETED BY APPLICANT
Receipt of this application must be made FIFTEEN days in advance of the date set forth for this outdoor fireworks display.
DATE(S) AND TIME(S) OF SHOWING:
click to sign
signature
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