Application For Pyrotechnic Operator'S Permit
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1DEPARTMENT OF PUBLIC SAFETY
OFFICIAL USE ONLY
PERMIT # _________________
DIVISION OF FIRE PREVENTION
Issue Date _________________
5700 East Tudor Road
Verification _________________
Anchorage, Alaska 99507-1225
APPLICATION FOR PYROTECHNIC OPERATOR’S PERMIT
(Authority 13 AAC 51.010)
Please print the following information:
Last Name
First
M.I.
Social Security Number
Date of Birth
Home Phone Number
Mailing Address
City
State
Zip
Business Name
Work Phone Number
Business Address
City
State
Zip
Application is hereby made for a Pyrotechnic Operator’s Permit which authorizes setting up and discharging Class B
and qualifying Class C special fireworks at public displays for which a display permit has been issued. In making
this application, I agree to abide by all requirements of the State Fire Marshal’s Office. I, hereby, authorize any
references listed herein to release any information and/or documents in their possession relative to my training,
experience, and ability as a pyrotechnic operator.
Signature
Date
Applicants must submit verifiable documentation of at least six (6) public displays in which they participated as an
assistant and must successfully pass the written examination administered by the State Fire Marshal’s Office prior to
receiving a permit.
DATE
LOCATION OF DISPLAY
PYROTECHNIC OPERATOR
PERMIT NO.
1.___________________________________________________________________________________________
2.___________________________________________________________________________________________
3.___________________________________________________________________________________________
4.___________________________________________________________________________________________
5.___________________________________________________________________________________________
6.___________________________________________________________________________________________
1. The examination score of 90% is required to pass and the closed book test must be completed in one hour.
2. Verification of experience is required prior to the issuance of the permit.
3. This permit is valid for three years from the date of issue. To renew, you must retest.
TEST REFERENCE MATERIALS: 1997 Uniform Fire Code Article 78, 13 AAC 50.25 (23) – (36), AS 18.72.
IF YOU NEED FURTHER INFORMATION, CONTACT MARIE COLLINS AT (907) 269-5625.
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