Fireworks Bylaw #5264 - City of Vernon

PAGE 11
BYLAW NUMBER 5264
SCHEDULE "A"
Attached to and forming
Part of Bylaw 5264
Application for Permit
Consumer Fireworks or Display Fireworks
Name of applicant: ______________________________________________________
Birth date: ___________________________ Age: _____________________________
Mailing address: ________________________________________________________
__________________________________ Phone: _____________________________
Email: ________________________________________________________________
Licensed Fireworks Supervisor Card
No.______________________________________
(attach photocopy)
THE APPLICANT HEREBY applies to discharge C0NSUMER or DISPLAY (check
one) Fireworks on property within the City as follows:
Location: ____________________________
Date: _______________________________
Time: (Start) ___________ (End) _________
Description of Special Public Event: ________________________________________
Estimated number of spectators: __________________________________________
Expected Type and quantity of Fireworks: ____________________________________
Contact name and phone for organizer or sponsor Special Public Event:
______________________________________________________________________
______________________________________________________________________
Contact name and phone for property owner: ________________________________
Information on requirements can be obtained through the Fire Department
Telephone: (250) 550-3565
READ CAREFULLY
THE APPLICANT CERTIFIES that the applicant understands and will be guided by the
provisions of Fireworks Regulation Bylaw, 5264, 2010, as amended from time to time,
and all applicable Provincial and Federal laws and regulations, as amended from time to
time, and any conditions or restrictions imposed in this permit by the Fire Chief.