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Appendix CC by vCji2faj

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									                                         APPENDIX “CC”

                            APPLICATION FOR PERMIT FOR
                      SUPERVISED PUBLIC DISPLAY OF FIREWORKS


       We hereby make application for a permit to conduct a public display of fireworks on the
              day of                              , 20   .

Said display to be held at

Firm providing fireworks



**Bond:        Amount $                                    ($1,000.00 or more)

Cash                  Personal                     Bonding Company               (Check one)

Has liability insurance been obtained?      Yes                   No

All accidents must be reported to the City of Sullivan and the Office of the State Fire Marshal
within thirty-six (36) hours of occurrence.

                                            Signatures of Applicants

                                                                                 Age:


                                                                                 Age:


                                                                                 Age:




                             [Supplement No. 10; 01-01-08]

								
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