HomeMy WebLinkAboutFIR2003-00022 - FIR Permit / Conditions - 6/12/2003 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)127-7262
Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670,ext,35211 -
Shelton,WA 98584
014
FIRE PROTECTION PERMIT FIR2003-00022
APPLICANT: ENTERTAINMENT FIREWORKS RECEIVED: 6/11/2003
CONTRACTOR: LICENSE: EXP: ISSUED: 6/12/2003
SITE ADDRESS: 7101 E STATE ROUTE 106 UNION EXPIRES: 12/12/2003
PARCEL NUMBER: 322335000014
LEGAL DESCRIPTION: 'SUNNY 9 LOTS 10-11 &8-9 N OF HWY
PROJECT DESCRIPTION: FIREWORKS DISPLAY PERMIT
GENERAL INFORMA71ON System Information
Type of Use: DIS
� Fire District: 6 Sprinkler Heads: Audible Switches: Pull Stations:
Hood&Duct t: N Flow Switches: Visual Devices: Door Releases:
Dry Chemical?: N Pressure Switches:: Smoke Detectors: Duct Detectors:
Wet Chemical?: N Zones: Heat Detectors:
Sprinkler?: N
Standpipe?: N SQUARE FOOTAGE FEES
Monitoring Station No.: First Floor: Type Amount Due Amount Paid
Auto Fire Alarm?: Second Floor:
Third Floor;: Fireworks Display Permit $100.00 $100.00
Fireworks Stand Permit $32.50 $32.50
Total: $132.50 $132.50
FIR2003-00022 Please refer to the following pages for conditions of this permit. 1 of 3
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CONDITIONS FOR r
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1 ) Site inspection required on day of shoot. Contact Fire Marshal's office(360)427-9670 ext. 273 to schedule inspection. X
This protect becornes nutt and void 6work or construction authorized is not commenced within IN days,ord construction orworkis suspenCed fora period of l 80days at anytime afterwork is
commenced. Evidence of mritnuationof work is a progress inspection within the 100 daypedod.
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FIR2003.00022 Please refer to the following pages for conditions of this permit, 2 of 3 ro
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Fireworks Permit Application
PO BOX 186 Permit # FIR '(DMA
426 W Cedar St
Shelton WA 98584 Receipt #
(360) 427-9670 ext 273
CK #
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: Olympia State: wA Zip: 98507-7160
Contact Number 360) 352-8911
Sponsor Information
Name: North Fourty Ventures
Mailing Address: 13 - 4603 NE University Village
City: Seattle State: WA Zip: 98105
Contact Number 2n�523-�117�
Washington State Fireworks License Information (Copy Required)
License No.: Date of
4085 Issue: 1-30-2003
❑ Pyrotechnic Operator License ❑ Fireworks Stand License
Bond or Certificate of Insurance
(Copy of Certificate/ Bond Required)
Provider: �..(� az
Insured:
Certified Holder:
Location of stand/display
Address: 7101 E State Route 106 Union - Alderbrook Inn
Directions to Site: Take Hwy. 16 west to Gorst, then ho south on Hwy. 3 to
Belfair. South of Belfair turn right on Hwy. 106 and go 15 miles
Parcel Number: to Alderbrook - - 322335000014
Legal Description:
Legal Property Owner:
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* * Please see the reverse side to complete your applicatioA0 0 2003
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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 '- AL(I Date _g-e)3
FOR OFFICIAL USE ONLY BELOW THIS LINE
Accepted By: Date: