Fillable Sale of Consumer Permissible Fireworks Application (Lake Havasu City)

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Sale of Consumer Permissible Fireworks Application (Lake Havasu City)

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LAKE HAVASU CITY FIRE DEPARTMENT
Fire Prevention Bureau
2330 McCulloch Blvd. N.
Lake Havasu City, AZ 86403
(928) 855-1141 lhcfire@lhcaz.gov
FD-291 Updated/CA 1-02-2020
Sale of Consumer Permissible Fireworks Application
(For Outdoor Locations)
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
Sales location:
Phone:
Applicant name:
Phone:
Applicant address:
Sponsoring agency:
Contact person:
Phone:
Please provide the following items with this application:
List of fireworks, including number and size.
Detailed site map with distances.
Temporary Use Permit with property owner approval.
Tent/Canopy size:
Quantity:
(Complete Tent/Canopy Permit Application and provide flame retardant certificate. Additional fee required.)
Sale dates:
Site security provided by:
City business license #:
$265 per location. (Additional fees required for tent/canopy permit.) Make checks payable to Lake Havasu City.
I reviewed the above information and am authorized to execute this application. I acknowledge that 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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Sale of Consumer Permissible Fireworks Application (Lake Havasu City)

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Completed 23 January 2021

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