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Home My WebLink AboutMIS93-0258 Fireworks - FIR Application - 6/28/1993 MASON COUNTY MISCELLANEOUS PERMIT APPLICATION - 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 • 427-9670 C) PLEASE PRINT #1 Owner � Phone # Fire District# Site Address SMCtL kVlf1-12-lL-4S:-1- —2P -- 611) 13E46179 /Aiity Mail Address City St Zip Applicant D A_�Prlyey Phone # 27 5774g-5 5 Applicant Address AC lob �/2y tzf7(fF_7 City 8�' 1P_ St Zip c76lL$ Directions to Site: Ph- a, GJ'L49X ` #2 Parcel No. �3 7 9- - - 666 Legal Description #3 Indicate by circling the applicable source if any water is on or adjacent to the property site: saltwater lake river creek stream pond wetland seasonal runoff marsh other #4 Project Start Date —Project Completion Date 74!! #5 Use of Buildiing Describe proposed construction 'Depending upon the type of permit,a floor plan and plot plan may be required. 'This permit is valid for 180 days from the date of issuance. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED CON- MENTS OF THE CONTRACTORS REGISTRATION LAW TRACTOR IN THE STATE OF WASHINGTON AND I AM RCW 18.27, AND AM AWARE OF THE MASON COUNTY AWARE OF THE ORDINANCE REQUIREMENTS REGULAT- ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT ING THE WORK FOR WHICH THE PERMIT IS ISSUED AND IS ISSUED AND THAT ALL WORK DONE WILL BE IN CON- ALL WORK DONE WILL BE IN CONFORMANCE THERE- FORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITH. NO CHANGES SHALL BE MADE WITHOUT FIRST WITHOUT FIRSTOBTAINING APPROVAL FROMTHE BUILD- OBTAINING APPROVAL FROM THE BUILDING DEPART- ING DEPARTMENT. MENT. X OWNER X BY DATE DATE Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Wells Water Lines Shorelines Drainage Plan Easements Septic Systems . Name of Fronting Street Indicate directional by Proposed Improvements Name of Flanking Street N, S, E, W etc. PLOT PLAN AREA FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICIAL USE ONLY Planning APP COND APP HOLD Building Fire Marshal Other Speci I Con iti n,-. C�9 Fees Permit Fee $ Plan Check Other Other State Building Fee TOTAL DUE $ APPLICATION DATE OF APPLICATION FOR RETAIL FIREWORKS STAND PERMIT TO: Governing body of city, town or county in which fireworks stand will be located APPLICANT NAME ADDRESS SPONSOR (IF OTHER THAN APPLICANT) ADDRESS LOCATION OF PROPOSED FIREWORKS STAND MANNER& PLACE OF STORAGE PRIOR, DURING & AFTER SALES DATES FIREWORKS SUPPLIER (ALL FIREWORKS MUST BE RETURNED TO SUPPLIER OR OTHERWISE DISPOSED OF BEFORE JULY 31ST) SIGNATURE OF APPLICANT •i•iL i. ��.. .pity . • �CC��'t 'i•77• �.��//�,. .`y,�;:::::'�;;:!::i/i': :`r!`\�::::,i��• •;•�•/ii. .�i��t „••/•�i). Qi��t 'i,••/ ••. i� ♦��` 'ii•99 i. ♦i•. /•��Ci Yr. ;4:' !��5•i ��`iV�Dd;;ii i,:$•r•J, '.• ':��ii��Ci(Yi�iii� tiii:.`2f°i ii/�i �`:•.`��iCC<..'iS%i•.' . N.�.,..,iiSii'. ., •. .. •�•� �,..• •�.,,,•.' ;�,,�!.��>,,...5:.••� :.`i4 i!�!d,i(I,I��i�i ;:�4:i��i��i�iii��i�i' ,`��i`ii��i�`�igi�ii•••�'• `•i•i .� •:•• PERMIT Year 4• (Must be conspicuously displayed at all times stand is open to the public) :::•. By virtue of having been granted a permit by the local governing authority and a license by r the State of Washington, the named person, firm or organization is hereby authorized to sell Class C Common fireworks at the location designated herein between the hours of 12 noon on June 28th and 12 noon on July 6th, in accordance with RCW 70.77. Sponsor Locatio /s/ 1 Ks ! Signature of Offici ranting Permit Signature of is al Issuing License Title Licensing' )''�' � Licensing Division Z% Agency �� 1 U OFFICE OF STATE FIRE MARSHAL siszi: Olympi WA 9 504 Date Permit # Date � .5 License # PERMIT NOT VALID UNLESS SIGNED BY BOTH LOCAL AUTHORITY AND STATE FIRE MARSHAL •�...\�.•:' .'.•r•••$;..::"iy.•`:�' - '.!/�••i•.,22`•��,:,��• .,•,�••.• 2:"��.•:: •./•••••n•).�••��..� �.!•�r••irn,.•iN`�`::: '.••••iiSi'(�`��i'••'%�l::�A •�-`C•`„�� i•, ••i!i• .��.• '��• II .�:.• •.��: '�•% •ii:<.••�ii.'�,.� 'i•i• •��ii:''.:��.• ,•iii:•...��ii•;.'�� ''�•••••iii:!...��i�•�•i �•I. -.-\•'1,,,,,. ,,••�'/•;�I,•,.,",\•:',\,,,, .�I�//.�11��:'1.'•\\��\`.� ,�i�j%��11•:�:'i��t'�\�\��. ,�I/'/j•rr��,:::�,.••,\�i�:' ,i�i��..rry�,�:�.••.`\�\�� 'i•i//•�rrr'::�:`..•1/r�Y �.�,�,�,•�;��. '.!•�/�4�L4�,' .�,�,��„�:��. r•�•i,•iiiii% :�..`�`��i��. .!•�/.•ii�iiS ),C.,��i�•p��. .i•�/i i�i�i%'•is�`��i!�. .!��r,•��....�`,�i,��!�!�• !!��i�•i i�iii�: ��.��/•�r�y. AUTHORIZATION TO PURCHASE CLASS C COMMON FIREWORKS Possession by the applicant of this completed application, signed by both the local issuing authority and the State Fire Marshal, authorizes the applicant to purchase Class C common fireworks for retail sale from the supplier shown at the location indicated. COPY "B"—Local Authority (instructions on reverse side of form) Form SF 601 QX A-252 RETAIL FIREWORKS STAND LICENSEE REQUIREMENTS 1. Fireworks may be sold only in roadside stands or buildings used for no other purpose. 2. A license and permit to operate a fireworks stand does not authorize the sale of articles other than fireworks. Only Class C common fireworks, not otherwise prohibited by RCW 70.77, may be sold in fireworks stands. 4. Only fireworks obtained from licensed wholesalers may be sold in licensed retail stands. 5. Fireworks can be sold only between the hours of 12:00 noon, June 28th and 12:00 noon, July 6th. 6. Fireworks may not be sold between the hours of 11:00 P.M. and 9:00 A.M. 7. At least one adult person(age 18 or over)shall be present at all times the fireworks stand is open to the public.No person under 16 years of age shall be allowed to sell fireworks or remain within a fireworks stand when it is open to the public. 3. Fireworks must be displayed in a manner to prevent handling by the public prior to sale. 9. At least two fire extinguishers, 21/2 gallon water or equivalent, must be accessible to .sales personnel. 10. Smoking and the discharge of fireworks shall be prohibited within 25 feet of the fireworks stand. 11. No fireworks shall be discharged within 100 feet of the fireworks stand. 12. "No Smoking" signs, with red letters at least two inches high, shall be posted at conspicuous locations and in plain view of all purchasers. 13. A list of fireworks that may be sold to the public,as furnished by the State Fire Marshal,must be prominently posted at each retail stand. 14 Fireworks stands shall be maintained free from any condition which increases,or may cause an increase of the hazard or menace of fire or explosion,or which may become the cause of any obstruction,delay or hindrance to the prevention,suppression or extinguishment of fire. 15. Adequate and safe means of exit shall be provided from all areas where fireworks are sold. 16. Fireworks stands shall be securely locked when not open for business,or all fireworks removed to a safe location approved by the local fire official. 17. Fireworks shall be promptly removed from the fireworks stand and either returned to the supplier or transferred to an approved storage facility, pending ultimate disposal prior to July 31st, at conclusion of the season. 18. Licensees are responsible to instruct all employees in these requirements. 19. Violation of these requirements constitutes a misdemeanor and may cause the immediate closure of the stand and.seizure of remaining fireworks in addition to the criminal penalties of law. INSTRUCTIONS Applicant. 1. Complete the application,giving the name of the person or firm applying for the license and,if other than the applicant,the name of the sponsor under which name the fireworks stand will be licensed and operated. 2. Provide the location of the stand,i.e.the address plus sufficient descriptive information to identify the specific site or structure to be used. 3. Indicate where the fireworks are to be stored prior to sales date,during sales period when stand is closed,and after sales date prior to July 31st(possession of fireworks by other than licensed wholesalers not permitted after this date).Storage locations are subject to local Fire Dept. approval. 4. Indicate the name of the licensed fireworks wholesaler from whom the fireworks are to be obtained. 5. Fill in the name of the sponsor,or name under which the stand will operate,and the address where the fireworks stand will be located, on the Permit. 6. Sign the completed application and present to the chief fire official of the city,town,county or fire protection district in which the stand is to be located. Fire Official/Local Governing Authority. 1. Make an investigation of the proposed fireworks stand location to determine whether it will be hazardous to property or dangerous to life. 2. Exercise reasonable discretion in evaluating fire and traffic hazards during hours of operation and the safe storage of fireworks before, during and after the sales period. 3. Submit your findings and recommendations to the governing body of the city,town,county or fire protection district for final decision or, in the event that this authority has been delegated to you, approve or deny the permit. 4. If approved, retain Copy B as your record for follow-up inspections and return Copies A and C to the applicant. Applicant. 1. Forward the completed Copies A and C to the State Fire Marshal. Include the$10.00 license fee.The license and completed Copy A will be returned to you,which will authorize the applicant to purchase Class C common fireworks from the licensed wholesaler.License applications must be made to the State Fire Marshal by June 10 of the year for which the license is desired. 2. The Permit must be conspicuously displayed at all times the fireworks stand is open to the public. 3. The storage of fireworks and any requirement/restrictions imposed by the local governing authority must be strictly observed. 4. Unsold fireworks must be returned to the supplier or otherwise disposed of prior to July 31st. NOTE: The applicant may apply to the State Fire Marshal for a license prior to obtaining local approval.However,the Permit is not valid nor the purchase of fireworks authorized until local approval has been obtained.License fees paid are non-refundable in the event local approval is denied.