Form Center

Fireworks Sale Permit Application

2. Organization/Business*
3. Kansas Sales Tax Number*
5. Responsible Party*
6. Application Date*
   Application Date
7. Fee
   $5000
9. Street Address*
11. City*
12. State*
13. Zip Code*
17. Display
18. Date of Event
    Date of Event
20. Street Address
24. Retail Sale
25. Dates Open
    Dates Open Start Date

    —

    Dates Open End Date
27. Street Address
29. Send payment to City of Clearwater PO Box 453 Clearwater, KS 67026
33. For Office Use Only
34. Permit Number
36. City Clerk
37. Fire Chief
39. Date
    Date
40. Date
    Date
Leave This Blank:


41. Print Only

* indicates a required field