HomeMy WebLinkAboutFIR2004-00015 Final Fireworks Stand - FIR Permit / Conditions - 6/29/2004 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.352
Shelton, WA 98584
P14
FIRE PROTECTION PERMIT FIR2004-00015
APPLICANT: TOM BARNES RECEIVED: 3/9/2004
CONTRACTOR: LICENSE: EXP: ISSUED: 7/20/2004
SITE ADDRESS: 141 NE CLIFTON LN BELFAIR EXPIRES: 1/20/2005
PARCEL NUMBER: 123294190027-
LEGAL DESCRIPTION: TR 2-B OF NE SE LOT: 2 OF SP#2929
PROJECT DESCRIPTION: FIREWORKS STAND
GENERAL INFORMATION System Information
Type of Use: STND Sprinkler Heads: 0 Audible Switches: 0 Pull Stations: 0
Fire District: 2 Flow Switches: 0 Visual Devices: 0 Door Releases: 0
Hood & Duct?: N Pressure Switches:: 0 Smoke Detectors: 0 Duct Detectors: 0
Dry Chemical?: N Zones: 0 Heat Detectors: 0
Wet Chemical?: N
Sprinkler?: N
Standpipe?: N SQUARE FOOTAGE FEES
Monitoring Company: N/A First Floor: Type Amount Due Amount Paid
Monitoring Phone No.:() - Second Floor:
Auto Fire Alarm?:N Third Floor;: Fireworks Stand Permit $100.00 $100.00
Total: $100.00 $100.00
FIR2004-00015 Please refer to the following pages for conditions of this permit. 1 of 3
CASE NOTES
FIR2004-00015
CONDITIONS FOR
FIR2004-00015
1.) A pre-opening inspection is required. Contact Fire Marshal at (360)427-9670 ext 273 to schedule. 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 any time 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 inspection.The ownerorthe agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection.
OWNER OR AGENT: DATE:
FIR2004-00015 Please refer to the following pages for conditions of this permit. 2 of 3
•J1/2312004 14:20 FAQ 360 427 7798 MASON CO PERMIT CTR
_ Z 002/006
Mason County
Fireworks Permit Application
PO BOX 186 Permit# FIRQO D
426 W Cedar St " -D D D j S
Shelton WA 98584 )
'7 (p -9670 ext 273 Receipt #
I �� vet L.
CK #
MAR 0 9 2004 - '
L-)Date Received
426 W, CEDAR ST:
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
revi�w- A permit will be issued upon satisfactory site inspection by the Fire Marshal.
Applicant Information ---
Name: ►^c5Vy-) F� T� n.S-f�Pr
Mailing Address: 5�t Al r Y�Kf �} Vim#
City: D3COMA State: t4),4 Zip: -92VO3
Contact Number (Z5 3tS?
Sponsor bxfo ma on
Name: _ ay-Al"
��c�#"��
Mailing Address: U ; -tt- L,3,L VJ N SD 1,10 2A.
City: C i V-br-1- State: ; WA Zip:
Contact Number
Wlashirigton State Fireworks License Information (copy Required)
License No.: Date of
�I\j 'Q!'r`)0--5I4 Issue: Zq{Lo
[] Pyrotechnic Operator License Fireworks Stand License
Bond or Certlffeate of Insurance
(Copy of Certificate/Bond Required)
Provider: CrA, L .
Insured; t�t 13 .Or vW r S I v,c AI" IS
1 �rtified Holder:
Location of stand/display
Address: 4 re; 1^.:l �wb I✓�i
Directions to Site;
Parcel Number:
Legal Description: TV. a
Legal Property Owner: 451/1
* * Please see the reverse side to complete your application �"
01/23/2004 14:20 FAX 360 427 779- MASON CO PERMIT CTR
U 003/006
The f0l].Owing 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 la areas to.
j • 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
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A0plicants Affidavit
certify that the information provided herein is accurate and that compliance with
all County, Stat ral laws pertaining to the sales or discharge of fireworks
shall be m ' 'ned.
Slgn Date
FOR OM CTAL USE ONLY BELOW THIS LM
Accepted By;
Date:
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