From Approved: O.M.B. No.2120-0027 08/31/2008
APPLICANTS - DO NOT USE THESE SPACES
Action
□
Approved
□
Disapproved – ”Explain under "Remarks"
Signature of authorized FAA representative
8. Area of operation (Location, altitudes, etc.)
9a. Beginning (Date and hour)
b. Ending (Date and hour)
10.
Aircraft
make and model
(a)
Pilot's Name
(b)
Certificate number
and rating
(c)
Home address
(Street, City, State)
(d)
No certificate may be issued unless a completed application
form has been received (14 C.F.R. 91. 101. and 105).
US Department of Transportation
Federal Aviation Administration
Region
Date
APPLICATION FOR
CERTIFICATE OF WAIVER
OR AUTHORIZATION
INSTRUCTIONS
Submit this application in triplicate (3) to any FAA Flight
Standards district office.
Applicants requesting a Certificate of Waiver or Authoriza-
tion for an aviation event must complete all the applicable
items on this form and attach a properly marked 7.5 series
Topographic Quadrangle Map(s), published by the U.S.
Geological Survey (scale 1:24,000), of the proposed operat-
ing area. The map(s) must include scale depictions of the
flightlines, showlines, race courses, and the location of the
air event control point, Police dispatch, ambulance, and fire
fighting equipment. The applicant may also wish to submit
photographs and scale diagrams as supplemental material
to assist in the
FAA's evaluation of a particular site.
Application for a Certificate of Waiver or Authorization must
be submitted 45 days prior to the requested date of the
event.
Applicants requesting a Certificate of Waiver or Authoriza-
tion for activities other than an aviation event will complete
items 1 through 10 only and the certification, item 17, on the
reverse.
1. Name of organization
2. Name of responsible person
3. Permanent
House number and street or route number
City
State and ZIP code
Telephone No.
mailing
address
6. FAR section and number to be waived
.
7. Detailed description of proposed operation (Attach supplement if needed)
FAA Form 7711 -2
(8-08) Supersedes Previous Edition
4. State whether the applicant or any of its principal officers/owners has an application for waiver pending at any other office of the FAA.
5. State whether the applicant or any of its principal officers owners has ever had its application for waiver denied, or whether the FAA has ever withdrawn a waiver from the applicant or any of its
principal officers/owners.
