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Temporary Permit Application (Fireworks Sales Tent)February 2021 APPLICATION FOR TEMPORARY (FIREWORKS SALES TENT) CITY OF LAVERGNE CODES DEARTMENT 5175 MURFREESBORO RD LAVERGNE, TN 37086 PHONE (615) 213-2624 FAX (615) 213-8692 All forms listed below MUST be submitted WITH this application before approval will be considered. *PLOT PLAN *CITY OF LAVERGNE APPLICATION *STATE OF TN FIREWORKS PERMIT *CERT OF INS-GEN LIAB *CERTIFICATE OF FLAME RESISTANCE TENT *CHECK FOR $500.00 DATE: ___________________ PERMIT #______________________________ LOCATION OF PROPOSED FIREWORKS SALES: ______________________________________________________________________ COMPANY NAME AND COMPANY OWNER NAME AND ADDRESS: _____________________________________________________________________ COMPANY NAME OWNER PHONE: ____________________________________ EMAIL ADDRESS REQUIRED: _________________________________________ ADD @lavergnetn.gov to your SPAM “allow list” APPLICANT NAME AND APPLICANT NAME ADDRESS: APPLICANT NAME PHONE: ___________________________________________ PROPERTY OWNER NAME AND PROPERTY OWNER ADDRESS: PROPERTY OWNER NAME PHONE: NAMES OF SALES PEOPLE AND PHONE NUMBERS: □$500.00 PERMIT FEE I hereby certify that I have been given a copy of the requirements for temporary fireworks sales and have completed the application to the best of my knowledge and understand that if I am found with any violations of the requirements that have been given to me that my permit will be revoked immediately and I will be shut down. APPLICANT SIGNATURE _________________________ DATE ______________ APPROVED □ DENIED □ FIRE OFFICIAL __________________________ DATE_____________________