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HomeMy WebLinkAboutFIR2005-00021 Final Fireworks Stand - FIR Permit / Conditions - 6/22/2005 - r k m m q / > kk (A \ \ M Ln k : > 2 R I g o > H \ co] 0 :2 / CD / �k 7 \ a m § \ ® � / 2 x- � � / z m % X R > 2 « m E a S " E § � \ ƒ 295999 / � ƒ a � " - n0 . w c $ 8 Z � N) 2 > � o 0 RL 0 p, z \ � Q U) om0O ® mE $ mm co / Cl) oD � x a -0 mm % 2 0 . \ 0m � m n mCL Go § CA)(n � 0 ■ 7 0 _1 0 m go m I ° / CD -9 ® > - ° \ CLOD k � Cl) ® m O � k E ƒ E ; 2 5 � g o o m e 2 E $ > . " q o \ \ / 0 2 m = m % $ M % A 0 E o O < Z m . m 0 § � ic � CD m Z cn 2 Q 2 > 2 Cl) 777 ƒ c CD b A CL a a 0 -0 CD CD CD — CD a n ± R § 0 / ) / kCD ¢ E -n f C m m xa0 o @ m 2Eg mmm b (n� � o O _ m \ § c 0) CA / 7 \ / � kk k \ \ \ \ CD C0 C E 2 .. .. .. � 0) CD 2 / � O /2 0 k � � -4 N $ % w � � � . o g < 0 n e 3 f \ \ CD C 2 7 / k } } / � . > 2 = m - � 00 o m 2� k § 2 ƒ2 g § § f CD C k } \ � / ¢ f / n 2 8 & » CA � R & < D / CDa : o7 Q - 0 0) —n 2 ] iCD 0 k D § O / / 0CD f o S ] E ° acnE 2J ® M / E ] 7 m = n a • c 0 M - - ] \ � =r /k / � E -0 � � kIS, / ■ CA 0 2 co / E E \ 8 o a) 3 g cD ( \ § E w / k � / : c / k 0 § m § % 2 E n -n O -n 0 2 � k \ � �� o o m % \ /� | Of Z / ƒ CD Cc 0 0 0 M 0 i8 0 _ � - M § o< 3 \ k & . Eo � � 22 C: ] r � � E¥ C / k Cr CD D CL C . �� \ o G m . . # � � f a ° 2 � § E :3 ofm § 8 � � - � : ) ( / $ ƒ \ . . E � m / { 3 max- 9cn o C -n CONCRETE MECHANICAL MANUFACTURED HOME CD Footings,l 390.%wks Data By Ribbons o Date By Gas Piping Date By FQ�dationavalls Date By Set-up N Date By INSULATION Date By Footings r Setbacks Floors FINAL I NSPECTION Date By Rate By Date By FRAMING Waft FIRE DEPARTMENT Date By Date By Date By PLUMBING Attic OTHER Groundwork Date By Date By WALLBOARD NAILING Date By ©.w.v Date By avatar LNr.e FINAL INSPECTION Date By Date By Date By Type of Insp. Pass/Fail Request Data Inspect. Date Done y Comments 0 �N o -O b Rv m � N � y y y i 9' �i j. W O W Mason County Fireworks Permit Application PO BOX 186 Permit# FIR ���— ��t 426 W Cedar St Shelton WA 98584 Receipt # .�( �- (360) 427-9670 ext 273 Date Received A Permit for the Retail Sales or Public display of fireworks is required. A completed application with required documentation and fees shall be submitted for Fire Marshal review. A permit will be issued upon satisfactory site inspection by the Fire Marshal. Applicant Information Name: TYSON DEVRIES Mailing Address: 23001 BE STATE G 3 BELFAIR 985 City: BELFAIR State: wA Zip: 98528 Contact Number ( 369 277-3778 Sponsor Information Name: BELFAIR ASSEMBLY OF GOD Mailing Address: SAME AS ABOVE City: State: Zip: Contact Number ( 360) 275-2858 Washington State Fireworks License Information (Copy Required) License No.: Date of 00906 Issue: ❑ Pyrotechnic Operator License ❑ Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required) Provider: SEE ATTACHE Insured: Certified Holder: Location of stand/display Address: 23961 NE SR 3 BELFAIR WA SAFEWAY Directions to Site: Parcel Number: 6-A - - C'CCU 10 Legal Description: Legal Property Owner: SEE ATTACHED RECEIVED * * Please see the reverse side to complete your application * * MA`( .� 7 "001� 426 W t--rDAR ST The following pertinent information MUST be provided on the site diagram below Locations and Setback distances from the back, sides and front of retail sales stands or designated display areas to: • Fire Hydrants • Property Lines • Buildings • Parking • Combustibles • Public Roads and Right of Ways • Fire Lanes • Private Roads and Right of Ways • Trees/Brush • Landmarks • Utilities and Gas • Mortar separation distance • Designated landing area Applicants Affidavit I certify that the information provided herein is accurate and that compliance with all o ty, State and Federal laws pertaining to the sales or discharge of fireworks shall be n d., Signe 7oQ- ate 10 FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: