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If different than Applicant
Note: This application and any permit issued as a result do
not confer approval to use flammable liquids and/or
flammable gases in any performance or display. A
separate application and permit is required for the use of
flame effects before a proximate audience.
Provide the name of the Pyrotechnician that will be in charge of firing
Provide Virginia certification number of the Pyrotechnician that will be in charge of firing
Diagram should include:
(1) the point at which the pyrotechnic devices are to be positioned and fired
(2) the fallout radius for each pyrotechnic device used in the performance
(3) the lines behind which the audience will be restrained
(4) the point of on-site assembly of pyrotechnic devices
MSDS information should include:
(1) the name, address and phone number of the manufacturer
(2) whether it is to be used with any special considerations or cautions
I attest the information provided is complete and accurate. I acknowledge and agree to
comply with all applicable requirements of the Virginia Statewide Fire Prevention Code (SFPC) and the referenced NFPA
1126-11 standard governing the use, storage and firing of pyrotechnics, even those not specifically covered or expressed
on this application.
I also acknowledge that if a permit is issued it shall be valid only at the location listed on the application and for the
specific date(s) and time(s) for which it is issued.
If approved to proceed, I acknowledge that such approval is conditional upon continued compliance with the SFPC. I
further acknowledge and understand that any SFPC violations identified after approval to proceed may result in denial of
final permit issuance or immediate suspension or revocation of a permit.
This field is not part of the form submission.
* indicates a required field