CITY OF DETROIT LAKES APPLICATION FOR DISPLAY OF
FIREWORKS/PYROTECHNIC SPECIAL EFFECTS
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Applicant Instructions:

	1. This application must be completed and returned at least
	   15 days prior to date of display.
	2. Fee upon application is $5.00 and must be made payable
	   to the City of Detroit Lakes.

Name of Applicant (Sponsoring Organization):_______________________

Address of Applicant:______________________________________________

Name of Authorized Agent of Applicant:_____________________________

Address of Agent:__________________________________________________

Telephone Number of Agent:_________________________________________

Date of Display:________________ Time of Display:__________________

Location of Display:_______________________________________________

Manner and Place of Storage of Fireworks/Pyrotechnic Special
Effects Prior to Display:__________________________________________

___________________________________________________________________

Type & Number of Fireworks/Pyrotechnic Special Effects to be
Discharged:________________________________________________________

___________________________________________________________________

Minnesota state law requires that this display be conducted under
the direct supervision of a pyrotechnic operator certified by the
State Fire Marshall.

Name of Supervising Operator:________________Certificate No.:_____


     I understand and agree to comply with all provisions of this
application and the requirements of the issuing authority, and will
ensure that the fireworks/pyrotechnic special effects are
discharged in a manner that will not endanger persons or property
or constitute a nuisance.

Signature of Applicant (or Agent):________________________________

Date of Application:______________________________________________

Required Attachments. The following attachments must be included
with this application:

	1. Proof of a bond or certificate of insurance in amount
	   of at least $200,000.00 per claimant and $600,000.00
	   aggregate per single occurrence. 
	2. A diagram of the grounds, or facilities (for indoor
	   displays), at which the display will be held. This
	   diagram (drawn to scale or with dimensions included)
	   must show the point at which the fireworks/pyrotechnic
	   special effects are to be discharged; the location of
	   ground pieces; the location of all buildings, highways,
	   streets, communication lines and other possible overhead
	   obstructions; and the lines behind which the audience
	   will be restrained. For proximate audience (e.g. indoor)
	   displays, the diagram must also show the fallout radius
	   for each pyrotechnic device used during the display.
	3. Names and ages of all assistants that will be
	   participating in the display.

The discharge of the listed fireworks on the date and at the
location shown on this application is hereby approved, subject to
the following conditions, if any:_________________________________

__________________________________________________________________

Signature of Fire Chief:__________________________  Date:_________

Signature of Issuing Authority:____________________ Date:_________