Fireworks Permit Application

2. Requirements:

   Please complete this form in its entirety and print legibly in order to prevent processing delays. 

4. General Information:
6. Name of Organization/Promoter(s): *
8. Phone Number(s) of Organization/Promoter(s): *
10. Address Where Firework Display Will Be Located:*
12. Date of Firework Display:*
    Date of Firework Display:
13. Fireworks Will Begin At: *
    Fireworks Will Begin At:

    Fireworks Will End Prior To: 11:30 PM

15. On-Site Emergency Contact(s) – Cell Phone Number(s) & Email(s): *
17. Number of Anticipated Attendees:*

    Complete a Festival or Event Permit Application if the event is anticipated to attract 300 or more daily attendees.

19. Date:*
    Date:
21. Signature:*
23. *

    The County of Madison requires individuals and organizations who will be conducting a firework display to comply with the minimum terms and conditions set forth in the Virginia Statewide Fire Prevention Code (SFPC) and the referenced National Fire Protection Association (NFPA) 1123 standard governing the use, storage and firing of display fireworks.

25. Notes:

    The County of Madison has no local ordinance imposing regulations on the storage, use, display, or sale of fireworks. State and Federal laws still apply. 

Leave This Blank:


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

    This field is not part of the form submission.

31. Submit

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