HomeMy WebLinkAboutFIR2004-00031 - FIR Application - 6/16/2004 Mason County
o PA9 OWL k K Firewotks Permit Application
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426 W Oeda$ St Permit # FIR QC
Shelton WA 98584 Receipt # `f—
(360) 427-9670 ext 273
CK # � ld�
6001-0d 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: Entertainment Fireworks, Inc.
Mailing Address: Po Box 7160
City: nl VML;a State: WA Zip: 98507-7160
Contact Number (360 ) 352-8911
Sponsor Information
Name: Grapeview Community Patriotic Celebration
Mailing Address: 579 NE Redbud Lane
City: Bremerton State: WA Zip: 98311
Contact Number ( 360 ) 476-8773
Washington State Fireworks License Information (Copy Required)
License No.: C-04085 Date of 2-3-04
Entertainment Fireworks, Inc Issue:
[ Pyrotechnic Operator License ❑ Fireworks Stand License
Bond or Certificate of Insurance
(Copy of Certificate/ Bond Required)
Provider: See Attached
Insured:
Certified Holder:
Location of stand/display 6t i6rl v-- E�i
Address: Offshore From E271 OkoTra 4em�; Grapeview WA
Directions to Site:
Parcel Number: - -
Legal Description:
Legal Property Owner:
* * Please see the reverse side to complete your application
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 County, State and Federal laws pertaining to the sales or discharge of fireworks
shall be maintained.
Signed Date
FOR OFFICIAL USE ONLY BELOW THIS LINE
Accepted By: Date:
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262
Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670,ext.352
11 Shelton, WA 98584
010
FIRE PROTECTION PERMIT FIR2004-00031
APPLICANT: ENTERTAINMENT FIREWORKS, INC RECEIVED: 6/16/2004
CONTRACTOR: LICENSE: EXP: ISSUED: 6/28/2004
SITE ADDRESS: 271 E OKONEK RD GRAPEVIEW EXPIRES: 12/28/2004
PARCEL NUMBER: 121082400060
LEGAL DESCRIPTION: TR 6 OF G. L, 2 &TAX 652-D & 652-A1A 271 E OKONEK RD GRAPEVIEW
PROJECT DESCRIPTION: FIREWORKS DISPLAY PERMIT
GENERAL INFORMATION System Information
Type of Use: DIS Sprinkler Heads: Audible Switches: Pull Stations:
Fire District: 6 Flow Switches: Visual Devices: Door Releases:
Hood & Duct?: N Pressure Switches:: Smoke Detectors: Duct Detectors:
Dry Chemical?: N Zones: Heat Detectors:
Wet Chemical?: N
Sprinkler?: N
Standpipe?: N SQUARE FOOTAGE FEES
Monitoring Company: First Floor: Type Amount Due Amount Paid
Monitoring Phone No.:()- Second Floor:
Auto Fire Alarm?: Third Floor;: Fireworks Display Permit $100.00 $100.00
Sprinkler System Plan $32.50 $32.50
Total: $132.50 $132.50
FIR2004-00031 Please refer to the following pages for conditions of this permit. 1 of 3
CASE NOTES
FIR2004-00031
CONDITIONS FOR
FIR2004-00031
1.) Inspection by the Fir ar be required before shooting the display. Contact the Fire Marshal at (360)427-9670 ext. 273 by july 2nd to set an
inspcetion time. X
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at anytime after work is
commenced. Evidence of continuation of work is a progress,inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of work is
by means of a progress i .The owner orthe age on the owners behalf,represents that the information prov7urate and grants employees of Mason County access to the above
described property and sr=u�refc r an cti n.
OWNER OR AGENT: DATE: �� D
FIR2004-00031 Please refer to the following pages for conditions of this permit. 2 of 3