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2. Permit fee for Public Fireworks Display:  $250.00

   Firework display contractors are required to provide proof of verifiable appropriate general liability insurance of $2,000,000 per occurrence and $4,000,000 aggregate coverage for each firework display event*.  

   *For firework displays with fallout areas in or adjacent to fireworks restricted areas**, or in proximity to other high-hazard or safety-threatening areas, insurance requirements may be increased by the fire code official to provide a minimum of $3,000,000 per occurrence and $5,000,000 aggregate coverage. **Fireworks-restricted areas are determined by the Authority Having Jurisdiction (AHJ), as approved by the South Jordan City Council.

   As determined by the fire code official, where standby personnel and equipment may be required to monitor the fireworks display, weather conditions, or to provide event standby or other required services; fees for such personnel and equipment will be collected based on the current City fee schedule. Requirement of personnel and equipment may be determined by the fire code official based on fire protection requirements, to include, but are not limited to: the size/type/unique elements of the display, display area, spectator separation, potential for hazardous or safety-threatening conditions, crowd control, proximity to firework restricted areas or other high hazards areas, and/or any other unique circumstances pertaining to the display.

4. Person or organization sponsoring the display:
6. Name:*
7. Date*
   Date
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone:*
16. Phone 2:
20. Contracted Firework Pyrotechnic Company:
22. Name*
24. Address*
26. City*
27. State*
28. Zip Code*
30. State of Utah Fireworks license number:*
31. Certificate of Insurance:*
33. Phone:*
34. Phone 2:
38. Location of the Event:
40. Date of the Event*
    Date of the Event

    Date of the Event
42. Address*
44. City*
45. State*
46. Zip Code*
48. List Type of Fireworks Being Used: Cakes, Shells, etc. and the sizes:*
50. Upload Site Plan with Fall Out Zone:*

    Must include:

    • Diagram of the location at which the display will be conducted.
    • Diagram of the site from which fireworks will be discharged.
    • The location lines behind which the audience will be restrained.
    • Spectator viewing area.
    • Parking areas.
    • Fallout areas.
    • Associated separation distances and structures shall be illustrated on the site plan.
51. Number of Attendees:*
53. Sign by Typing Your Full Name Here:*

    Note: Permits and approval will not be granted without all information being submitted. DO NOT ASSUME THAT THE APPLICATION IS APPROVED UNTIL NOTIFIED BY THE FIRE DEPARTMENT.

    Events require fire department stand-by "fire watch."

    Unless approved otherwise, costs associated with fire watch will be invoiced to the responsible party listed above.

Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field