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HomeMy WebLinkAboutFIR2015-00025 Final Fireworks Stand - FIR Permit / Conditions - 6/28/2015 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 Nrp Mason County Bldg. III Phone: (360)427-9670, ext. 352 426 W. Cedar St Shelton, WA 98584 854 FIRE PROTECTION PERMIT FIR2015-00025 APPLICANT: JOHN MILLER RECEIVED: 5/26/2015 CONTRACTOR: LICENSE: EXP: 2/2015 ISSUED: 6/2 SITE ADDRESS: 22950 NE STATE ROUTE 3 BELFAIR EXPIRES: /22/2015 PARCEL NUMBER: 123325000044 2/2015 LEGAL DESCRIPTION: SAM B. THELER'S HOME &GAR TRS TR 19-B PROJECT DESCRIPTION: Fireworks stand permit 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?: 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 FIR2015-00025 Please refer to the following pages for conditions of this permit. Page 1 o 8 CASE NOTES FIR2015-00025 CONDITIONS FOR FIR2015-00025 FIR2015-00025 Please refer to the following pages for conditions of this penult. Page 2 of 8 • 1.) ner/ t is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28, X FIR2015-00025 Please refer to the following pages for conditions of this permit. Page 3 of 8 2.) Sales: WAG 212-17-21505 Retailers of fireworks-General provisions. Fireworks may be sold from 12:00 noon to 11:00 PM on June 28 through 9:00 PM on July 5. Fireworks may not be sold between the hours of 11:00 PM fro ne 28 through July 3. Fireworks may not be sold from 12:00 midnight to July 4 through 9:00 AM on July 5. Fir r ay be sold from 12:00 noon to 11:00 PM on each day from the 27th of December through the 31 st of December of each year. X Only Division 1.4G consumer fireworks, obtained from state-licensed wholesalers, not otherwise prohibited by chapter 70.77 RCW or local ordinance,and ho' y rCdacts incidental but related to these products, may be sold in retail fireworks stands. X Firewo s stand locations: WAG 212-17-21509 Retailers of fireworks-location. (1) Activities or uses subject to this rule shall not be limited in location except where such activities or uses are prohibited or controlled by local development regulation, traffic safety or road construction standards. (2) Temporary retail fireworks stands shall not be located more than 150 feet from a private way, fire department access road, public road, street or highway as measured by an approved route around the exterior of the stand. The minimum requirements for private way shall be determined by the local authority having jurisdiction, but shall not exceed the requirements of locally adopted street, road and access standards. (3)Any two retail fireworks stands shall be at least 100 feet apart or shall be separated by a road, street or highway not less than 30 feel in width. (4) Retail fireworks stands shall be located as required by table 212-17-21509 in this section and attached to the permit.The minimum required area surrounding the stand shall be marked or flagged, except that flagging and marking shall not block a sidewalk or pedestrian pathway. Flagging need not exceed twenty feet in any direction. (5) Retail fireworks stands shall not be located closer than 100 feet from any motor fuel dispensing station, retail propane dispensing station, flammable liquid storage, or combnustible liquid storage. Retail fireworks stands shall not be located closer than 300 feet from any bulk storage of flammable or combus' le liquid or as, including bulk plant dispensing areas. X _ Surround n area arond fireworks stands: AC212-17-21511 Retailers of fireworks-areas around the retail fireworks stand. (1)The minimum areas around the retail fireworks stand specified in WAG212-17-21509 shall be kept free of accumulation of dry grass,dry brush and combustible debris. No parking shall be permitted within this minimum area. (2) No motor vehicle or trailer my be parked within twenty feet of a retail fireworks stand except when delivering , loading or unloading fireworks. (3) Fireworks shall not be discharged within 100 feet of a retail fireworks stand. Signs reading"NO FIREWORKS DISCHARGE WITHIN 100 FEET'in letters at least 2 inches high, with the principal stroke of not less than one half inch, on contrasting background„ shall be conspicuously posted on all four sides of the stand. (4) No smoking shall be allowed within the retail fireworks stand or within the minimum flagged off area. Signs reading"NO SMOKING WITHIN 20 FEET` in letters at least 2 inches high, with the principal stroke of not less than one half inch, on a contrasting background, shall be conspicuously posted on all four side ,o a stand. X \ Electrical su y and usage: WAG 212-17-21513 Retailers of fireworks stand use and construction. (1) Fireworks may be sold From: (a)A permanent structure which meets provisions of WAG 212-17-21505(3). (b)Temporary, stable structures made of wood, metal, fiberglass or other material.Any temporary fireworks retail stand greater than 400 square feet FIR2015-00025 Please refer to the following pages for conditions of this permit. Page 4 of 8 shall meet the requirments of a permanent structure,except tents or canopies as defined in the International Fire code retail stand greater than 400 square feet shall meet the requirements of a permanent structure. (c)Tents , canopies, or structures utilizing temporary membrane material. All tents, canopies or temporary membrane materials structures shall be made from fire retardant material or treated with fire retardant as identified in the International Fire code. Any tent, canopy or temporary membrane material structure falling within the scope of the International Fire code shall comply with those requirements. When those requirements are in conflict with other provisions of these rules, the more restrictive provisions shall apply. (2) Battery powered equipment, electrical equipment cords which are used in conjunction with a retail fireworks stand or a temporary storage structure or location must be listed by a recognized laboratory and used in accordance with that listing. If electrical power is supplied by an extension cord, the size of the cord, the length of the cord and the amperage and the voltage supplied shall be in compliance with the requirements of the National Electrical code, current edition.The cord shall be protected as necessary from drive-over and other physical damage. No additional permits from a city or county or state official having jurisdiction shall be required for these temporary uses except as specified in subsection(5)of this section. (3)All heating units shall be listed by a recognized testing laboratory and shall be used in accordance with the listing. Heating sources shall have"tip over' and temperature overheat protection. All heating devices shall have sealed type elements( i.e, oil filled or water filled radiator type). Open flame heating devices are prohibited. (4) Generators which use combustible fuel and which are at least twenty feet from the retail fireworks stand or the temporary fireworks storage structure shall be allowed. Generator fuel shall be limited to not more than five gallons and stored at least twenty feet from all stands. (5) Compliance with the National Electrical code, current edition, shall be required for all new, permanent electrical installations, including temporary power drops, subject to possible fees. (6) Retai a e f firew s and other products which are holiday related shall be from buildings used for no other purpose. X Storage asso" ed with retail fireworks: WAC212-17-21517 Retailers of fireworks-Temporary fireworks storage associated with the retail fireworks stand operation. (1)Temporary fireworks storage is not permanent fireworks storage.Temporary fireworks is defined as storage associated with retail fireworks sales and may only be from June 13 through July 13 and from December 12 through January 10 of the following year. Permanent fireworks storage is associated with retail or wholesale fireworks activites when the period of time of storage is other than, or longer than that specified for temporary storage. Temporary fireworks storage shall be in accordance with this section. Permanent fireworks storage is subject to the Internaitonal Fire Code and the local ordinances. (2) Delivery of fireworks to a location, or storage of fireworks in a facility, not authorized by the license and permit is prohibited. If the approved storage location is outside the jurisdiction issuing the permit, the authority issuing the permit shall notify the appropriate authorities of the jurisdiction in which the storage is to be(coated. (3)A temporary fireworks storage facitlity or a temporary fireworks storage location shall be authorized as a part of a license and permit if it meets the requirements specified herein. (4) No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. (5) Storage of fireworks authorized by a retail license and permit is legel only during the periods specified in this section. (6) Fireworks may be stored: (a) In a locked or secured retail fireworks stand-,or (b) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than 20 feet from the retail fireworks stand during hours of retail sales,or (c) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than 20 feet from an inhabited building where the term"inhabited building" is defined as in the International Fire Code; or (d) In a magazine which meets the minimum standards of a type 4 as prescribed by the International Fire code, and which is not less than 10 feet from an inhabited building where inhabited building" is defined as in the International Fire code: or (e) In a locked or secured metal or wooden garage, shed, barn or other accessory building, or anything similar which is not less than: 20 feet from an inhabited building for storage of fireworks for one or two retail stands; or 30 feet from an inhabited building for storage of fireworks for three or more stands. The term"inhabited building is defined as in the International Fire code. FI R2015-00025 Please refer to the following pages for conditions of this permit. Page 5 of 8 (7)The local authority having juisdiction may reduce the minimum separation required of this section provided that safety of life and property is not diminished. (8) No Cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. (9) Temporary fireworks storage structures may be inspected prior to use and other inspections may occur on other days as warranted. There shall be no additio a c r e r all such inspections. X 3.) Valid Pe ust be on-site. X OWNER/BUILDE cknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, Including any easement holder or parties of interest regarding this project. The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PER APPLICATION OF 0 DAYS WILL INVALIDATE THE APPLICATION. T Sig a r 'ZZ ,—/- Date G� N Pt`�1 l OWNER - REPRESENTATIVE - CONTRACTOR Print Name (Circle one to Indicate) FIR2015-00025 Please refer to the following pages for conditions of this permit. Page 6 of 8 "n ic 55 N CONCRETE MECHANICAL MANUFACTURED HOME Footings I Setbacks Date By Ribbons M Gas Piping � C Intenor Date By Interior-Date By Date By 0 Exterg L. r Date By Exterior-Date By �_� __.,__ O N INSULATION = Cn Point Load I Isolated Footings Ba I SLAB INSULATION Date By _ Z Date By Data By FIRE DEPARTMENT Foundation Wells Floors Date By Date By Data By DECKS FRAMING Wails Date By Date By Data By PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Date g Date By Type: y Date By D.W.V DRYWALL Type- Int Brace Wall Date By � M Date By y Date By FINAL 1 SPE TION N Water Line Fire Separation O Date By Date By Dale By7AJ# Cn O Pass or Request Inspect. c pe of Insp. CA Fail Date ate Done B Comments 0 ( GUO ID f m d cc N M Vol t�o 11 O 7 fl O 7 y O -w S N M <D 3 (0 lD J O 00 Mason County Fireworks Permit Application PO B4 Permit#FiR 186 - 426 Cee dar St W Shelton WA 98584 y (360)427-9670 ext 273 Receipt # Z�1 5 _ 7 Q RECEIVED CK # -7710 � MAY 2 6 2015 Date Received �h W CEDAR 1� A Permit for the Retail Sales or Public display of fireworks is required. A carnpleted 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. F pplicant Information ame: So �, P'(i I (er iailingAddress: 11Sk w 1-lr4-� Cm jtcr City: S e'L "k State: o r�- Zip: 5 183 F o Contact Number 20 -cj32 w. �le--j-7'3ID �vQ 1. cA ,_, FNa information Address. City: State: t,)/ �ZiP: 5 83 go -- Contact Number s o) Washington State.Fireworks License Information (Copy Required] License No.: Date of W S R FZ- U 2 2 7 Issue: �., 12� , -2, S ❑ Pyrotechnic Operator License Q'Fireworks Stand License Bond or Certificate of Insurance (copy of Certificate/Bond Required) Provider Insured: o�. ���K -To S'oI,s Certified Holder: g,, P 2 4-A­I-z LLB FDirecbons n of standidisplay : 2 to Site: Parcel Number. 12 3 3 z s- z 5- o v r y Legal Description: Legal Property Owner: — C �R *. * Please see the reverse"s" ode t� coamplete your a ,; i RECEIVED MAY 262015 426 W. CEDAR ST. The following a mformati6h MVST be pr d9 on the site below Locations and S from the bac sides d at of retail sales stands deli ay areas to: • A ydrants • Property Lines • 7Lanes PCombles Public Roads and Right of Ways Fire • Private Roads and Right of Ways Trees/Brush Landmarks • Utilities and Gas Mortar separation distance • Designated landing area SC 44zL, o"V 14 �N R GE Applicants Affidavit I certify that the information provided herein is accurate and Z4ance with all Coun State and Fede f aws pertaining to the sales or discharge of fireworks shall main . Signe Date FOR OFMCLAL USE ONLY BELOW THIS LINE Accepted By. Date: FIRE MARSHAL 11 h�S 1 r y `L .I1 •j =tit' ',', ,i lr� � ky.•;wry• . k Jr J 4. 8 G ul'.i� b rc.yr.y _ 8 x 32 stand No Parking 20 feet Retail Fireworks Stands - Minimum Clearances Motor Motor Vehicle Vehicle Traffic Tlaffic PUBLIC.•.,-• P VATE Buildings Combustibles Property Line Parking ROaD` WAY BACK OF STAND 20 FT. 20 FT. 5 FT. 20 FT. FT. J 5 FT. SIDE OF STAND 20 FT. 20 FT. 5 FT. '; `> 5.FT. FRONT OF STAND 40 FT. 40 FT. 22`0 ; ` 120 F FT. 20 FT.** 20 FT.** O P G r( RECEIVED C, -to io' : S v pp1�GPe SS��N,µNE�I :'s V�e3f' rC9t.4 PL`OIQp o OF Q Qok �� JUN 09 20,a gP 0p15 F, y,cPS t p,V 426 W. CECA 5T. $moo 4t°o � RECEIVED MAY 2 6 2015 .) ' 426 W. CEDAR ST. FIREWORKS STAND SITE PLAN SITE DIAGRAM DATE UPDATED: LOCATION NAME PARCEL NUMBER:/Z3 3 Z.5-6,10C)C) ORDINANCE OF:I:i r)& /7Z,y/�,� �2v0 UIc'70ti� jITE ADDRESS:__2_L_ij AF ST.k2u_r , -3 STRUCTURE TYPE: lifJ��J Q CITY&STATE.17c'ZF/`9ip-- LJ,4 STUCTURE SIZE: 3 2- CROSS STREETS:S-o,-n2�Fei -3 & c� C[ 9 STRUCTURE F e _ice.� ACES: �/✓� S ,o - 4k 44 �`'+ d-`~' '� K roc �- •• a - - �R x• �1A f RECEIVED MAY 2 6 2015 426 W. CEDAR ST. A�HMGSDMgT4rF Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal 15-0769 CONSUMER FIREWORKS RETAIL SALES STAND LICENSE $5H►L'S OF�Vt Stand Number: SN-09855 Licensee Data Operational Data Boomtown Productions, L.L.C. Wholesaler: Jake's Fireworks 15156 NW Hite Center Rd. County of Operation: Mason Seabeck, WA 98380 Operated For: Licensee License Number: WSPFL-02027 Stand Operated By: Johnathan Miller Phone Number:(360) 620-1732 Date of Issue:April 20, 2015 Date of Expiration:January 31, 2016 Consumer Fireworks Retail Sales Stand Licenses issued after May are ONLY valid for New Years Sales This license is NOT valid without a permit from a local fire code officialfauthonty having jurisdiction. This license allows for operation of a single location/stand for retail sales to the public of state legal consumer fireworks purchased only from a licensed fireworks wholesaler. THIS LICENSE PORTION ACCOMPANIES YOUR LOCAL PERMIT APPLICATION FIREWORKS LICENSE AGREEMENT This agreement is made between Joe Solis, as licensor and Boomtown Productions,LLC as licensee for the said purpose of allowing retail sales of Consumer Fireworks from the followring location: 22950 NE STATE ROUTE 3 BELFAIR RECEIVED Parcel tax ID#123325000044 MAY 2 6 2015 426 W. CEDAR ST. The licensor represents that it owns,or controls the use of the lot as listed above and agrees to grant licensee the right to operate a retail firework stand on the premises for the period of June 20,2015 through July 8,2015 for a license fee of$1000.00 due no later than July 15'h, 2014. The licensee shall pay all cost involved in the erection,operation and maintenance of the stand,and shall guarantee that the premises shall be returned to the original condition after removal of the stand. The licensee will provide liability insurance coverage and provide to the licensor,before occupancy.The insurance shall name the licensor as an additional insured,and licensee will hold the licensor harmless from any claims arising from the maintenance or operation of the structure. The licensee shall pay for and obtain licenses and permits required by law and post any performance bonds which might be required. The licensee shall guarantee that the stand is operated in a business like manner and adhere to all local state regulations. If the property is sold,ingress/egress changed,or location impacted due to construction or the like,then this license is subject to revocation and refund of any payments made. LICENSOR: LICENSEE: Joe Solis-Owner Jo at Miller/Boomtown Productions,LLC Phone 360.440.4873 e.360.62 1732 ? DATE(MMIDDNWY) AIR© CERTIFICATE OF LIABILITY INSURANCE FG 262015 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACI NAME: PHONE FAT David Connolly Insurance Agency Inc A/C,No.Ext: A/C No)- 9393 Bayshore Drive NW ADDRESS' INSURER(S)AFFORDING COVERAGE NAIL a Silverdale WA 98383 INSURER A National Fire 8.Marine Insurance Co.[72] 20079 INSURED INSURER B Halo Fireworks LLC INSURER C 15156 NW Hite Center Rd INSURERD: INSURER E Seebeck WA 98380 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EX LTR TYPE OF INSURANCE INSR 1MdD POLICY NUMBER MMIOONWY td M/DD/YYYY LIMITS GENERAL LIABILITY EACH C;-DiPRENCE $ 1,000.000 X ClEa NTED ".i�MtdEF.';,iri 3E^1FF.i<_L L1BIL;Tv �REhAISE" o 'urrEn 100.000 CLAIMS-b1ADE FRI VED E xiP i Anv onE gar or.!' S 5.000 A Y 72LPS022488 04/01/2015 04/012016 _,Er,>_.NA_6:0w lt<0sir, $ 1,000.000 ENEF� n;.oF'EG.A7 i 2,000 000 GE` ASGP•E TE LL'dlTAPP'LIEJ 2,000.000 X F'C'L IC:7 cam- AUTOMOBILE LIABILITY -`rM51NED S!N(;LF lii,"I' ufc`Tl�1v 3014L"P.,-UP""er:arcri $ ALL 50DIL�I'J_UR`'!Par ac:rosn!) ; rh:Av rYvTVE:: iPERTY D,AMAI E UMBRELLA EXCESS LIAB WORKERS COMPENSATION - - <:TH- AND EMPLOYERS*LIABILITY YIN A� (Mandatory in NH) E L DISEASE-EA EN =E i If 4eE d35 TL I Dr"�M9r -- ?N O=::PcRi--.T ON =i cis E L C4SO-5 -F; Y LNy.!T DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (Attach ACORD 1D1.Additional Remarks Schedule.if more Space is required) Boomtown Productions LLC.Mason County,and property owner Joe Solis are listed as additional insured per form M5350a(05l0RECE • Lq(i-� 22950 State Route 3 Belfair,WA98528 1�Ji MAY 2 6 2015 426 �A0 r'FnAp c CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Boomtown Productions,LLC THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN 15156 NW Hite Center Rd ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Seebeck WA 98380 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD � 1 FIRE PROTECTION BUREAU,,,i�rf FIREWORKS LICENSING PROGRAM PO Box 42600 H®®® Olympia WA 98504-2600 wumr n.X « (360)596-3914 FAX: (360)596-3934 APPLICATION FOR RETAIL FIREWORKS STAND PERMIT TO Governing body of city,town, or county in which DATE OF fireworks stand will be located. T APPLICATION 1 Applicant Nam``ee� Address,City,State ;l G I ';-I (o iV I,J Sponsor(If other than applicant) Address,City,State e W 9'Z6 Location of proposed fireworks stand ]Enclose drawing of stand location] 2 2 -1 s7c) N& S-t j 12,,,.E .3 l3,°l Fu ,r� 04 Manner and place of storage prior,during,and after sales dates RECEIV D -� 41're-ti7 !k 3 c�a r -e�e.4 �� S�>x State-Licensed Fireworks Supplier �&k-�r n'r-e w c.Ac-f 426 A CEDA ST - -- - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - STAND PERMIT FIREW0','\'-K1,,-.03 For the Fireworks Sales Year of. (Must be conspicuously displayed at all times while the stand is open to the public) By virtue of having been granted a license by the State of Washington and this/en, ermit from as the local governing authority, the naor organization is hereby authorized to sell U.N. 0336 1.4G Consumer firewordesignated herein between the following date and times: Sales for July 41h Sales r D From: From: To: �W To: Spons r Location S naWrjkteM P it Signature of Applicant 11VV++ `nTitleT CT aELp INS- cy Date ` SUB L cones �`�l fIPF1`v Ff~.I,C- ottit°� 4REc- ALL 1110 OVISSII Nt "jtl To sk"._ . License Na ,",SIBRITv OF OWNERF1E1D 1t15�EGT10`THI! ,r, i FRO" tFcYJ$�• TI'm Li ense Dumber 1 T10NS WNER/cONTR RANT TO A?:Y ThTE Lr V PROVAL O -- � TE RIGHT TO 3000-420.013(R 3/09) L _