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2. 
4. Applicant Name*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number (include dashes)*
12. Email Address*
14. Name of Pyrotechnic Operator*
15. Address*
17. City*
18. State*
19. Zip Code*
21. Phone Number (include dashes)*
22. Email Address*
24. Certificate Number*
25. Expiration Date*
27. Location of Display*
28. Address of Display*
30. Date of Display*

    (Permit fee is $100)

31. Time of Display*
33. Manner and Place of Storage of Fireworks Prior to Display*
35. Type and Number of Fireworks to be Discharged*
37. Names and Ages of all Assistants that will be Participating in the Display*

    All assistants must be 18 years of age or older.

39. Use Type: Residential/Commercial *
    -- Select One --Single (101)Single Attached (102)Two-Family (103)3-4 Family (104)5 or More (105)Condo (106)Hotel, Motel (213)Garage, Carport, Shed (438)Mobile Home (401)Amusement, Recreational (318)Church, Other Religious (319)Industrial (320)Parking Garage (321)Service Station, Repair Garage (322)Hospital, Institutional (323)Office, Bank, Professional (324)Public Utility (325)Schools, Other Educational (326)Stores, Mercantile (327Other Nonresidential (328)Structure Other Than Building (329)
41. Attach Required Documents Here*
    • Copy of State Certificate
    • Proof of bond or certificate of insurance in the amount of at least $2,000,000.00.
    • Diagram of site at which the display will be held. This diagram (drawn to scale or with dimensions included) must show:
      • The point at which the fireworks are to be discharged
      • The location of ground pieces
      • The location of all buildings, highways, streets, communication lines, and all other possible overhead obstructions
      • The lines behind which the audience will be restrained. 

    PDF files only

    Acceptable characters for file name: A-z 0-9 ~ ! (  ) - + = [ ] { } , . _

43. Minnesota State Law*

    By checking this box I understand that Minnesota State Law requires that this display be conducted under the direct supervision of a Pyrotechnic Operator certified by the State Fire Marshal.

    1. I agree.
45. Agreements/Acknowledgements *

    By Checking this box, I hereby apply for an outdoor fireworks permit and acknowledge that the information above is complete and accurate. That the work will be done by a licensed, certified and qualified operator in conformance with the applicable NFPA Standard, the Minnesota State Fire Code, Minnesota State Stature, and codes and ordinances adopted by the City of Winona. I understand that this is not a permit but only the application for a permit and if issued a permit, I will ensure that the fireworks are discharged in a manner that will not endanger persons or property or constitute a nuisance, and that work is not to start without a permit. The work shall be in accordance with the approved plan in case of work which requires review and approval of plans.

    I have attached all necessary plans, specifications, and documentations to the permit application in the space provided because I understand that paper copies will no longer be accepted.

    1. I agree
47. Payment Agreement*

    By Checking this box, I understand that I will receive an invoice sent to the email provided and when I receive this invoice I agree to call and make a payment by phone to the City of Winona finance department at 507-457-8262 in reference to the invoice number and I understand that I will not receive a permit until the invoice is paid in full.

    1. I agree.
49. 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.
51. Electronic Signature*
Leave This Blank:


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

    This field is not part of the form submission.

55. Submit

* indicates a required field