PENNSYLVANIA PERMIT APPLICATION
PERMIT FOR PURCHASE AND DISPLAY OF CONSUMER FIREWORKS
AS PERMITTED BY 35 P.S. 1275.2
This Permit authorizes the Applicant ___________________________________________________________,
to purchase consumer fireworks from __________________________________________________________,
for the display of consumer fireworks at _________________________________________________________
________________________________ ; ____________________________________________ County, PA.
The date for this consumer fireworks (1.4g) display event is _________________________________________
which shall not be less than three days from the date of delivery of this Permit to the retailer of consumer fireworks.
The grant of this Permit is a non-transferrable privilege, which is valid only for the date identified as the consumer
fireworks display event day. The applicant agrees that he or she will fire or discharge the consumer fireworks as
or with a competent operator, and that the consumer fireworks display will not be hazardous to property or
endanger any person or persons. The applicant releases the Municipality and retailer of the consumer fireworks
from liability, losses and/or claims, which may arise from the display of consumer fireworks.
Signature of Municipal Officer
Printed Name of Municipal Officer Title of Municipal Officer
Daytime Telephone Number Permit Number