Fireworks Permit Application

Organizationfield type single line
Organization name, if applicable
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Applicant Name*field type single line
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Applicant Address*field type single line
(Street, City, Zip)
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Applicant Phone*field type single line
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Applicant Email*field type email
Property Ownerfield type single line
Property owner's name if not applicant
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Display Location*field type single line
Property address where the display will take place
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Date of Display*field type date
Display Time*field type single line
The time the display will begin and end (ex. 9:00 p.m. - 10:00 p.m.)
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Attendees*field type single line
Anticipated number of people attending the display
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Licensed Operators
Please list all State Licensed Operators running the event:
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- Namefield type single line
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- Addressfield type single line
  (Street, City, Zip)
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Add another operator
This application must be made at least 60 days before the display and must include the following documents:
* Liability Insurance certificate in the amount of $1,000,000 naming the City of McHenry as an additional insured
* A diagram of the property showing all buildings, structures, spectator & display locations with setbacks
* List of mortars and their sizes
* Approval from the McHenry Township Fire Protection District
* Copy of valid business Pyrotechnic Distributor License
* Copy of valid business Federal Explosive License / Permit
* Copy of Illinois DNR Storage Certificate for business
* Illinois Hazardous Material Certificate for business
* Copies of valid Illinois Operator Licenses for all those working the event
*McHenry Township Fire Protection District Display Inspection Form - this form may be downloaded here and uploaded with this application or emailed to: mjohnson@cityofmchenry.org - This is the same form that the MTFPD will require.
This application authorizes the City of McHenry and the McHenry Township Fire Protection District to enter the property to perform inspections.
File Uploadfield type file upload
Upload any required documents here
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Acknowledgement*field type checkbox
AcknowledgementI understand that checking this box constitutes a legal signature and confirms that I have filled out this form to the best of my ability.
Signature*field type signature
Date*field type date

Fireworks Permit Application

Licensed Operators