Application to Purchase and Fire Fireworks
Complete this form prior to purchasing fireworks from an authorized vendor.
Applicant Information
Name of Applicant
*
Age of Applicant
*
Phone # of Applicant
*
Format: (000) 000-0000.
Email
*
example@example.com
Mailing Address of Applicant
*
Is This Application For a Person or an Organization?
*
Personal
Organization
Name of Sponsoring Organization
Address of Sponsoring Organization
Is This Application for High Hazard Fireworks or Family Fireworks?
*
High Hazard (NRCAN License Required)
Family Fireworks (No License Required)
NRCAN Supervisor Certificate #
NRCAN Supervisor Certificate Expiry
-
Year
-
Month
Day
Date
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Display Information
Location of Display
*
Date of Display
*
/
Month
/
Day
Year
Date
Time
*
Hour Minutes
AM
PM
AM/PM Option
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Supplier Information
Name of Supplier
*
Address of Supplier
*
Date of Purchase
*
/
Month
/
Day
Year
Date
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Rules and Cost Recovery
General Rules:
Applicant must be the person supervising the firing of the fireworks.
Applicant must be 19 years of age or over.
Signed approval must be obtained prior to purchase.
Submit your approved application to licensed vendor.
Signed permits will be sent via email to the address indicated in the form.
Please allow up to 2 business days for processing.
Agreement
*
I CERTIFY THAT I WILL ABIDE BY THE GENERAL SAFETY RULES AND SPECIFIC INSTRUCTIONS OF THE MANUFACTURER GOVERNING A PARTICULAR FIREWORK. I HEREBY ACKNOWLEDGE THAT IF FOR ANY REASON I AM UNABLE TO FIRE THE FIREWORKS AT THE LOCATION DATE AND TIME SPECIFIED ABOVE, THAT I AM REQUIRED TO OBTAIN A NEW AUTHORIZATION PERMIT PRIOR TO FIRING THE DISPLAY. I FURTHER ACKNOWLEDGE THAT FIRING THE DISPLAY WITHOUT A VALID AUTHORIZATION PERMIT WILL BE CONSTITUTED AS A VIOLATION UNDER THE FIRE PREVENTION ACT.
Cost Recovery
*
I understand that contravention of the terms of this permit that requires a response by the Inuvik Fire Department may be subject to actions as stated in Town of Inuvik By-law #2650/FC/20 Open-air Burning and Fireworks By-law and/or FM.021 Fees & Charges Schedule A
Date of Application
*
-
Year
-
Month
Day
Date
Submit
Should be Empty: