Form Center

Fireworks Sale Permit Application

2. Organization/Business

3. Permit Number

5. Responsible Party

6. Application Date
   Application Date

8. Fee

   $500

   $500

9. Kansas Sales Tax Number

11. Street Address

13. City

14. State

15. Zip Code

19. Display

21. Street Address

23. Date of Event
    Date of Event

27. Retail Sale

29. Street Address

31. Dates Open
    Dates Open Start Date

    —

    Dates Open End Date

35. For Office Use Only

37. Meeting Approved by the City Council At:

39. City Clerk

40. Fire Chief

42. Date
    Date

43. Date
    Date

Leave This Blank:


44. Print Only

* indicates a required field