Form Center

2. Event
4. Specific Location
5. Address
7. City
8. State
10. Zip
12. Inclement Weather Date and Time
    Inclement Weather Date and Time

    Inclement Weather Date and Time
13. Date and Time of Event
    Date and Time of Event

    Date and Time of Event
15. Individual, group, or organization sponsoring event
17. Name
18. Address
20. City
21. State
23. Zip
24. Phone Number
26. Fax Number
27. Email
29. Operator
31. Name
32. Address
34. City
35. State
37. Zip
38. Phone Number
40. Fax Number
42. Fireworks Supplier
44. Name
45. Address
47. City
48. State
50. Zip
51. Phone Number
53. Fax Number
55. Aerial Fireworks Display
57. List type with a Diameter of less than 3 Inches
59. 1
61. 2
63. 3
65. 4
67. 5
69. Salutes

    1. <3
    2. 3
    3. 4
    4. 5
    5. 6
71. List type with a Diameter of 4 Inches
73. 1
75. 2
77. 3
79. 4
81. 5
83. Salutes

    1. <3
    2. 3
    3. 4
    4. 5
    5. 6
85. List type with a Diameter of 5 Inches
87. 1
89. 2
91. 3
93. 4
95. 5
97. Salutes

    1. <3
    2. 3
    3. 4
    4. 5
    5. 6
99. List type with a Diameter of 6 Inches
101. 1
103. 2
105. 3
107. 4
109. 5
111. Salutes

     1. <3
     2. 3
     3. 4
     4. 5
     5. 6
113. Ground Displays
115. Number 1
117. Type
119. Size
121. Number 2
123. Type
125. Size
127. Number 3
129. Type
131. Size
133. Number 4
135. Type
137. Size
139. Number 5
141. Type
143. Size
145. Personal
147. Operator(s)
149. Assistant(s)
151. Monitor(s)
153. Plans*
155. General Information
     • Display of Fireworks shall comply with the requirements of the National Fire Protection Association Standard 1123 “ Code for Fireworks Display” as referenced in Florida State Statute 791. 
     • A diagram of the ground on which the fireworks display is to be held shall be provided. It shall include: 
       • Location of discharge area(s)
       • Required separation areas
       • Spectator viewing area d. Location of buildings, roads, overhead obstructions, fire hydrant(s) 
     • Proof of insurance from the sponsor and the operator shall be provided.
     • An inspection of the display site shall be scheduled to be completed a minimum of three days prior to the event. Non-compliance with the standard or any other City ordinance may be grounds for denial of the display.
     • Fire department personnel shall be required to be on site for purposes of providing fire protection. The sponsoring organization shall be responsible for paying for these services in accordance with Chapter 95 of the City of Lake Mary Code of Ordinances.
157. I do hereby agree to the terms of this permit
159. Signature
161. Date
     Date
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163. 1. Receive an email copy of this form.
164. Email address

     This field is not part of the form submission.

165. Submit

* indicates a required field