HomeMy WebLinkAboutFIR2006-00029 Fireworks - FIR Permit / Conditions - 12/27/2006 MoMASON 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
to FIRE PROTECTION PERMIT FIR2006-00029
APPLICANT: NORTH MASON PEE WEES ED: 6/27/2006
CONTRACTOR: LICENSE: EXP: JZL Al, RECEIVED:ISSU
SITE ADDRESS:( 2386 A STATE ROUTE 3 - EXPIRES: 12/27/2006
PARCEL NUMBER: --123294100090
LEGAL DESCRIPTION: PCL 1 OF BLA#04-37 PTN TR 9 NE SE EX S 29/194
PROJECT DESCRIPTION: Fireworks Stand
GENERAL FINFORMATION System Information
Type of Use: OTH Sprinkler Heads: Audible Switches: Pull Stations:
,a Fire District:
Hood&Duct t: Flow Switches: Visual Devices: Door Releases:
Dry Chemical?: Pressure Switches:: Smoke Detectors: Duct Detectors:
Wet Chemical?: Zones: Heat Detectors:
Sprinkler?:
Standpipe?: SQUARE FOOTAGE FEES
Monitoring Company. First Floor: Type Amount Due Amount Paid
Monitoring Phone No.:()- Second Floor:
Auto Fire Alarm?: Third Floor;: Fireworks Stand Permit $100.00 $100.00
Total: . $100.00 $100.00
FIR2006-00029 Please refer to the following pages for conditions of this permit. 1 of 3
CASE NOTES
FIR2006-00029
CONDITIONS FOR
FIR2006-00029
1.)• Shall meet minimum requirements of the Mason County Standards for the Operation of Retail Fireworks Stands (see attached).X 16PI
Inspection by the Fire Marshal required before opening.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 owner orthe 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 inspect /
OWN ER OR AGENT: � y DATE: h a
1
FIR2006-00029 Please refer to the following pages for conditions of this permit. 2 of 3
1viason County
Fireworks Permit Ap licati.on
A PO BOX 186 p
426 W Cedar St Permit# FIR
Shelton WA 98584
(360) 427-9670 ext 273 Receipt # ea-2-�
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 Xnf9rmation
Name: Q S
Mailing Address: — 0
City: —ttState: C Zip: 5Z
Contact Number . ��(�) -�?,) _ -2 9
Sponsor orm tion
Name: 0.,
Mailing Address- I c
City: i ✓ State: - l Zip: 17E S2 F
Contact Number
Washington State.Fireworks License Information (Copy Required)
License No.: W Sp P7L —0'06UCp Date of
Issue: 3--��i—u(�
❑ Pyrotechnic Operator License eworks Stand License
Bond or Certificate of Insurance
(Copy of Certificate/Bond Required)
Provider: ; [ �- Lill
Insured: vices �c
Certified Holder: n e S
Location of stand/display
Address: 0 316 In I Z
Directions to Site:
Parcel Number.: ! • - - Q OC
Legal Description:
Legal Property Owner: yVj.,c
* * 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
a a
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 maintain
Signed Date ��3
FOR OFFICIAL USE ONLY BELOW THIS LINE
Accepted By: Date: