ST. ROSE PHILIPPINE DUCHESNE CATHOLIC PARISH SHERIFFS SIGNATURE REDACTED.PDF

MAR1COPA COUNTY BOARD OF SUPERVISORS
301 West Jefferson Street, 10th Floor, Phoenix, Arizona 85003
APPLICATION FOR FIREWORKS DISPLAY
Arizona Revised Statutes § 36-1603 requires every display shall be handled by a competent operator. and shall
be of a character and located, discharged and fired so that it will not be hazardous to property or endanger any
person. Before a permit is granted, the operator. location and handling of the display shall be approved by the
sheriff of the county. After a permit is granted. the sale. possession. use and distribution of fireworks for the
display shall be lawful for that purpose only. Permits are not transferable or assignable.
Further. A.R.S. § 36-1604 requires that the governing body shall require each applicant to provide a satisfactory
bond of not less than $500. or a copy of the certificate of liability insurance in a principal amount usually not less
than $1 million, conditioned upon payment of all damages which may be caused to persons or property by
reason of the display.
Complete the following application and submit to the Clerk of the Board of Supervisors, 301 W. Jefferson Street,
10th Floor. Phoenix. 85003 (602-506-3766) at least 30 days prior to the event date.
All applications must have the following documentation attached:
1. Proof of appropriate bond or insurance payable to Maricopa County.
2. Map of display area.
3. List of fireworks to be discharged. The Director of Display for the fireworks company is expected to be
licensed and/or trained by the City of Phoenix or have other verification of expertise.
4. Verification from local fire department that they were notified of event, date. location and time.
EVENT INFORMATION
Name/Organization: St. Rose Philippine Duchesna Catholic Parish
Name of Event: Fall Festival Fireworks
Event Address: 2825 W Rose Canyon Circle, Anthem AZ 85086
Date and Time of Event: October 14 2017 © aprrox. 9:00pm - 9:30pm
DISPLAY DIRECTOR (permit will be issued to the following)
Name: Sarah Harris Phone:
Business: Fireworks Productions of Arizona Fax: 480-423-5430
Address: 17034 S 54th Street, Chandler AZ 85226
SUBMIT APPLICATION AND REQUIRED DOCUMENTATION TO:
Maricopa County Clerk of the Board of Supervisors Email: ClerkBoard©mail.maricopa.gov
301 W. Jefferson Street. 10 th Floor Fax: 602-506-6402
Phoenix, Arizona 85003
For questions. please call the Clerk of the Board of Supervisors at 602-506-3766.

FOR DEPARMENT USE ONLY:
SHERIFF'S OFFICE RECOMMENDATION
The State Fire Marshal or local fire chief has reviewed the site and fireworks described by the applicant and
found them to be satisfactory.
9 -/.7-6z
Sheriff's Office Signature Date
PERMIT FOR FIREWORKS DISPLAY
The above application having been filed pursuant to A.R.S. § 36-1603, together with other proper
documentation; permission is granted to the above-named applicant to conduct a fireworks display on the dates
set forth in the application. IN THE EVENT OF POSTPONEMENT OF SAID SHOW, the display will be given
not later than one (1) week from the date specified above.
Approved by the Maricopa County Board of Supervisors:
DATED tnis day of 20
Clerk of the Board, authorized signature