1

Applicant Information

 *

Applicant Information

Name (First, Last)

Date of Birth

Sponsor or Company Name

Address

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Email Address

Phone Number

2

Stand Location

 *

Stand Location

Site Address

Site City

Site State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Site Zip Code

Owner Name (First, Last)

Address

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Email

Phone Number (include area code)

3

Fireworks Information

 *

Fireworks Information

Wholesale Vendor of Fireworks

Responsible Agent

Address

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Carrier Transporting Fireworks to/from Site

Responsible Agent

Address

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

4

Please Upload All Required Permit Documentation

 *

Please Upload All Required Permit Documentation

Copy of the lease agreement or written permission to use the land for the fireworks sales stand Click button for uploading file Clear Maximum size allowed: 25 MB Allowed types: .gif, .jpg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt, .zip, .t2s

Copy of public liability insurance for the amount of $1 million or more for each sales site. Click button for uploading file Clear Maximum size allowed: 25 MB Allowed types: .gif, .jpg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt, .zip, .t2s

Copy of the Larimer County building permit for each site Click button for uploading file Clear Maximum size allowed: 25 MB Allowed types: .gif, .jpg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt, .zip, .t2s

Copy of the invoice from the fireworks wholesaler showing the number, type, pyrotechnic composition, and total weight of all fireworks to be sold Click button for uploading file Clear Maximum size allowed: 25 MB Allowed types: .gif, .jpg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt, .zip, .t2s

A drawing of the sales site(s) showing all distances. This drawing shall include: A. Setbacks to the property lines, public roads and highways, and all nearby structures. B. Location of parking and parking barriers. C. The location of any on-site storage. D. Exit locations. E. Fire extinguisher locations. F. The location of any fuel or heat sources, such as auxiliary generators, gasoline storage, etc. G. The location of where electrical power will be obtained, and how it will be routed to the stand. Click button for uploading file Clear Maximum size allowed: 25 MB Allowed types: .gif, .jpg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt, .zip, .t2s

Copy of the State of Colorado retailer of fireworks license Click button for uploading file Clear Maximum size allowed: 25 MB Allowed types: .gif, .jpg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt, .zip, .t2s

Provide list of all individuals that will work at the fireworks stand, must include name and date of birth Click button for uploading file Clear Maximum size allowed: 25 MB Allowed types: .gif, .jpg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt, .zip, .t2s

5

I attest that the information submitted is accurate, and that I have read and reviewed the application requirements.

I attest that the information submitted is accurate, and that I have read and reviewed the application requirements.

Yes, the information submitted is accurate, and I understand the application requirements.

I have questions about the application requirements and request follow up.

6

Electronic Signature/Acknowledgement of Application Information

 *

Electronic Signature

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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