ANTHEM FIREWORKS SHERIFFS SIGNATURE REDACTED.PDF

10/15/2026 0:22 48089931798

MARICOPA 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 shal 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 properly by
teason of the display.

Complete the following-application and submit to the Clerk of the Board of Supervisors, 301 W. Jefferson Street,
10" Floor, Phoenix, 85003 (602-808-3766) 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 Courtity,
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

NamelOrganization: AX wy-bh 2mm

Name ofEvent’ Mews Yenrs Fy ¢ Vicew WK D $5 Play

Eventaddresss YITO3 Ale (Vayilan Peau Parkway , Auten Az!

| Date and Timo of Event December BIA 2020 @ PCiooPm

DISPLAY DIRECTOR (permit will he Issued to the follow na)

Name: "Ramboy Row Ani Phone
Business: ‘RE, eu , PW Fax:
Address:

SUBMIT APPLICATION AND REQUIRED DOCUMENTATION TO:

Email: ClerkBoard@mall.maricopa.gov

Maricopa County Clerk of the Board of Supervisors
. Fax: 602-506-6402

301 W. Jefferson Street, 10” Floor
Phoenix, Arizona 86003

For questions, please call the Clerk of the Board of Supervisors at: 602-506-3768.

Received Time Oct. 15. 2020 12:17PM No. 7634

96086

PAGE 62/02

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.
yr. YA “BA 533 10/26/2020

7 SHeriff's Office Signature Date

PERMIT FOR FIREWORKS DISPLAY

The above application having been filed pursuant to ARS. § 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 this, day of 20...

Clerk of the Board, authorized signature