Lansing, MI

Application for Firework Display

Steps

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Step One

Contact us
If you desire assistance or have questions about this form, you can email us at city.clerk@lansingmi.gov, call us at (517) 483-4133, or visit us in the City Clerk's office, located on the 9th floor of City Hall (124 W Michigan Avenue, Lansing, MI 48933).
Instructions
Application for a license required by this section shall be made in writing to the City Clerk at least 30 business days before the proposed date of the use or display unless application within a shorter period of time is approved by the Fire Marshal. Fill out and submit this form. Bring the materials listed below to the City Clerk's office to complete the application process.
Materials
1. Non-Refundable License fee of $150.
2. Proof of an insurance policy naming the City as co-insured, available for the payment of any damages arising out of an act or omission of the licensee or his agents, employees, or subcontractors, covering the following: (a) At least $500,000.00 for property damage; and (b) at least $500,000.00 for injury to one person and $1,000,000.00 for injury to two or more persons resulting from the same occurrence.
2. Proof of an insurance policy naming the City as co-insured, available for the payment of any damages arising out of an act or omission of the licensee or his agents, employees, or subcontractors, covering the following: (a) At least $500,000.00 for property damage; and (b) at least $500,000.00 for injury to one person and $1,000,000.00 for injury to two or more persons resulting from the same occurrence.
3. Copies of State issued identification for each person who will operate the display.
4. If the applicant is a nonresident person, written appointment of a resident agent to serve as legal representative upon whom all process in an action or proceeding against the person may be served.
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Step Two

Applicant Information
First Name*
Last Name*
Phone Number*
Email Address
Home Street Address*
City*
State*
Zip code*
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Step Three

Business Name
Business Phone Number*
Business Email Address
Business Street Address
City
Zip code
State
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Step Four

Business Owner First Name
(If different from Applicant)
Last Name
Owner Phone Number
Owner Email Address
Street Address
City
State
Zip Code
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Step Five

Date and Time of Display*
Date and Time of Display Start Date
Date and Time of Display Start Time
—
Date and Time of Display End Date
Date and Time of Display End Time
Exact Location of Display*
Type and Quantity of Fireworks to be used in Display*
Manner and location of the storage of the fireworks prior to the display *
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Step Six

Operator #1 Information
First Name*
Last Name*
Age*
Description of Relevant Experience*
Operator #2 Information
First Name
Last Name
Age
Description of Relevant Experience
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Step Seven

Operator #3 Information
First Name
Last Name
Age
Description of Relevant Experience
Operator #4 Information
First Name
Last Name
Age
Description of Relevant Experience
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Step Eight

Operator #5 Information
First Name
Last Name
Age
Description of Relevant Experience
Has the applicant, any person with an ownership interest in the applicant, or any person who will operate the display had any citation or conviction for, or guilty plea to, a violation of the laws of the United States, any State or any local unit of government regulating the sale, use, or possession of fireworks?*
1. Yes
2. No
If yes, please explain:
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Step Nine

Treasury Request Form
Link
Print, fill out, and fax/mail Treasury Request Form*
1. I have faxed or mailed the Treasury Request form to the City Clerk.
Print, fill out, and mail or fax the Treasury Information Request Form to the City Clerk. The form is available at the link above. Business licenses will not be issues to people in debt to the City. The Treasury Request Form must be completed and submitted before your application can be processed.
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Step Ten

I certify that neither the Applicant nor any person with ownership interest is in default to the City of Lansing. By my signature, I swear (or affirm) that all information provided in this application is true.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Approved by Police Department
Date
Date
Approved by Fire Marshal
Date
Date
Amount paid
Date paid
Date paid
License number

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Application for Firework Display

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