Life Safety Division • City of Duluth Fire Department
615 West First Street • Duluth, MN 55802
Phone: 218-730-4380 • Fax: 218-730-5902
Email: lifesafety@duluthmn.gov • Website: www.duluthmn.gov/fire/
Pyrotechnic Permit Application - $275.00 Fee
Site Information-
Site Address:_______________________________________ Owner/Business Name: ___________________
Description of Event: ________________________________________________________________________
Event Date(s) ____/_____/_________ to ____/_____/_________
Applicant Information-
Name:________________________________________ Phone Number_________________________
Address:___________________________________ __________________________________________
Email Address:________________________________________________________________________
Permit Contact (if different):
Name:________________________________________ Phone Number_________________________
Pyrotechnic Operator:
Name:________________________________________ Phone Number_________________________
Certificate #:___________________________________
Attach the following documentation:
Fireworks Operator License from the MN Dept of Public Safety
Event Site Map and Storage Plan prior to display
Insurance – Certificate of Liability Insurance
I hereby acknowledge that the information above is correct and that the burning will be in conformance with DNR regulations
and City of Duluth Codes and Ordinances.
_________________________________________ _________________________________
SIGNATURE DATE