FIREWORKS PERMIT
This permit is being issued under authority of Chapter 40, Town of Newbury Ordinances. This permit is not an authorization to violate any State law or other chapter or provision of the Town of Newbury Ordinances. The authorizing official holds no liability in the issuance of this permit. It is the responsibility of the permittee to refer to all applicable State laws and Town of Newbury Town ordinances, and to operate within their provisions.
Permittee:
Name: ____________________ Address: ____________________________
DOB: ___________ Phone (s): ____________________
Location of Display: (If different from above)
Class / Type / Description of Fireworks:
BELOW TO BE COMPLETED BY AUTHORIZED OFFICIAL FOR THE NEWBURY FIRE DEPARTMENT
Date of Display: Authorized Times: until
Specific Restrictions Regulating display:
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