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2. DOWNLOAD APPLICATION
   CLICK HERE TO DOWNLOAD APPLICATION
4. NAME OF ORGANIZATION:*
6. ORGANIZATION'S PHYSICAL ADDRESS
8. Address*
10. City*
11. State*
12. Zip Code*
14. NOTE:

    All correspondence will be sent to this address. Please be certain that this is an address that your organization’s principal contact person has access.

16. EMAIL ADDRESS:*
18. Please check if you would like correspondence sent via email:*

    1. Yes
    2. No
20. PURPOSE OF ORGANIZATION:*
22. ORGANIZATION'S PRINCIPAL OFFICERS:
24. FIRST NAME AND LAST NAME:*
25. TITLE:*
27. FIRST NAME AND LAST NAME:*
28. TITLE:*
30. FIRST NAME AND LAST NAME:
31. TITLE:
33. PRIMARY CONTACT:
35. NAME:*
36. PHONE NUMBER:*
38. Address*
40. City*
41. State*
42. Zip Code*
44. DATE ESTABLISHED IN SEASIDE:*
46. TAX EXEMPT STATUS:*
48. NOTE:

    Copies of IRS 501.C.3 Letter of Certification, Franchise Tax Board Certificate, or other proof of non-profit status must be attached and included at the time the application packet is submitted.

49. FILE UPLOAD:*
51. PROPOSED STAND LOCATION:*
53. STAND LOCATION PROPERTY OWNER:*
55. Address*
57. City*
58. State*
59. Zip Code*
61. Phone Number*
63. NOTE:

    An original letter from the property owner stating that a fireworks booth is allowed on the property must be included at the time the application is submitted.

64. FILE UPLOAD:*
66. DATE SALES TO BEGIN:*
67. DATE SALES TO END:*
69. NOTE:

    Fireworks may only be sold from noon on June 28th until 10:00pm on July 5th and only between the hours of 9:00 AM and 10:00 PM.

73. FIREWORKS SUPPLIER:*
74. NAME OF SUPPLIER:*
76. Address*
78. City*
79. State*
80. Zip Code*
82. CONTACT PERSON NAME:*
83. PHONE NUMBER:*
85. IS A COPY OF THE STATE FIRE MARSHAL RETAIL FIREWORKS LICENSE ATTACHED?*

    1. YES
    2. NO
87. NOTE:

    The original State Fire Marshal Retail Fireworks License must be available and posted in the stand at the time of the Fire Department Inspection or the fireworks permit will not be issued.

89. AGREEMENT:

    I shall indemnify, defend and hold harmless the City of Seaside, its officers, officials, agents and employees from, and against any and all liability, loss, damage, expense, cost (including without limitation costs and fees of litigation) of every nature arising out of or in connection with the sale of fireworks by the applicant organization or its failure to comply with any of its obligations set forth in the City resolutions, regulations, orders or otherwise required by the City, except such loss or damages caused by the active negligence, sole negligence, or willful misconduct of the City. 

91. SIGNATURE (TYPE NAME):*
92. DATE:*
    DATE:
94. APPLICATION SUBMITTED BY:*
95. PHONE NUMBER:*
97. Address*
99. City*
100. State*
101. Zip Code*
105. ATTESTATION:

     TO THE BEST OF MY KNOWLEDGE, ALL THE INFORMATION PROVIDED IS TRUE AND CORRECT:

107. SIGNATURE (TYPE NAME):*
108. DATE:*
     DATE:
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110. 1. Receive an email copy of this form.
111. Email address

     This field is not part of the form submission.

112. Submit

* indicates a required field