HomeMy WebLinkAboutFIR2003-00028 Fireworks Stand - FIR Permit / Conditions - 6/24/2003 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
Shelton, WA 98584
FIRE PROTECTION PERMIT FIR2003-00028
APPLICANT: NORTH MASON PEE WEES RECEIVED: 6/23/2003
CONTRACTOR: LICENSE: EXP: ISSUED: 6/24/2003
SITE ADDRESS: 203 NE STATE ROUTE 300 BELFAIR EXPIRES: 12/24/2003
PARCEL NUMBER: 123294290001
LEGAL DESCRIPTION: TR 10 OF NW SE LOT B EX 591
PROJECT DESCRIPTION: Fireworks stand
GENERAL INFORMATION System Information
Type of Use: STND
Sprinkler Heads: Audible Switches: Pull Stations:
Fire District: 2 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 Station No.: First Floor: Type Amount Due Amount Paid
Auto Fire Alarm?: Second Floor:
Third Floor;: Fireworks Stand Permit $100.00 $100.00
Total: $100.00 $100.00
FIR2003-00028 Please refer to the following pages for conditions of this permit. 1 of 3
CASE NOTES
FIR2003-00028
CONDITIONS FOR
FIR2003-00028
This project becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended fora period of 180 days at any time after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period.
Owner or Agent:_ _ Date:
FIR2003-00028 Please refer to the following pages for conditions of this permit. 2 of 3
Masorr County
Fireworks Permit Application
PO BOX 186 Permit# FIR
426 W Cedar St
Shelton WA 98584 Receipt #S Z2DQB 1165
(360) 427-9670 ext 273
US NVa3J 'M 9Zb CK # 50,30
9 Nor Date Received to I a3 &.
03A1303a
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: H UDCe5 ( en_e5i'&,4
Mailing Address:
City: State: wr9 Zip: gS57a 5
Contact Number (360) 'a75-6Wj Ct)t 71 0- 31X cell 73 l- 3F5 4`t
Sponsor Information
Name: 61 ovtis eC \_0C-f-5,
Mailing Address: /�l a oc,
City: eKck 1L State: �,p►9 Zip: q'16S'M
Contact Number p 31 3g�4
Washington State Fireworks License Information (Copy Required)
License No.: O a Date of
Issue: 1 Lt a003
❑ Pyrotechnic Operator License Fireworks Stand License
Bond or Certificate of Insurance
(Copy of Certificate/ Bond Required)
Provider: A-m; a�
Insured:
Certified Holder: �v� Cp 'C eS
Location of stand/display ?.-,:Dj
Address: a F l�tc�u
Directions to Site: l h ,_v(�'�� tom' o ckF C,
Parcel Number: a - -
Legal Description: Cf w g
Legal Property Owner: ,' / tF
* * 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 maintairved.
Signed (� Date71
FOR OFFICIAL USE ONLY BELOW THIS L/I,�NE
Accepted By:— ����� Date:w Lc;�3 —3