HomeMy WebLinkAboutEVE2008-00001 - PLN General - 7/23/2008 PREAPP: JULY 31, 2008
TIME: 1:15/1:30-2:30
Mason County
Carnival, Circus or Like Enterprises Applickfbtlly couNTY
MCC Section 5.12.010
Return To: Mason County Dept of Community Development Phone: (360) 427-9670 ext. 352
PO Box 186 Fax: (360) 427-7798
Shelton, WA 98584
This application must be completed, signed and forwarded to the Mason County Dept of Community Development Office
at least sixty (60)days prior to the first day of the event. Any misrepresentation in this application or deviation from the
final agreed upon route and/or method of operation described herein, may result in the immediate revocation of the
permit. Please type or print information clearly and attach additional sheets as necessary. Once application has been
submitted,the applicant will be required to schedule a pre-application meeting with county staff to discuss event details.
EVENT
Event Name: Ay t r�/ e Na iA Sa/V e_G aAlt FC, cis\/
Event Date(s): Auq 30 3 i Sr Day(s) of the Week: S„n Time(s): 1 .4,vi
U.-r, U c r F^o
Event Address: y5 jj +p 2a,,ie .3 Sie, /4-
Legal Description (TPN): T& 5 n n
Size of Property (if applicable):
l 2 -
Event Crowd Size: Participants: 300 Spectators:�lt Volunteers/Staff: 7S11'
Has event been held previously? No WYes ❑
If yes, what were the dates of the event &where?
Any change from previous events? NoJK Yes ❑
If yes, please attach list of changes for this year's request.
APPLICANT INFORMATION
Applicant's Name: L c 31 rw- e To-u M in e r
Applicant's Address: 70 E G rt c n woott /Af 1+o n L"Cl
Phone Home: 3 2T7"�f� Work:
Numbers: 5S'eO
Pager: Cellular: 2S3-�1Q.�"
Fax: Email:
Owner's Name:
Owner's Address: 5�;,,..P c, s 4l e7ve
Phone Numbers: Home: Cellular: .253' 7v�-1887
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EVENT DETAILS
Check appropriate category below and fill in details or numbers, size and type. Leave blank if not applicable.
Alcohol: ❑ Will cohol be served or available? Will alcohol be sold? No ❑ Yes ❑
No,O-% Yes❑
Booths/Vendors: How many booths? How many vendors?
Entertainment: Sound System: Describe: ,
Accoustic ❑ Amplified'
Food Will foodl be se d or available? Will food be sold? No❑ YeslK
No ❑ Yes. If Yes, by whom?
Water: Potable? Non-Po ?
Electricity Source: Generators: How many? Size:
+ PUD PLC
Sanitary Facilities Kr How m ny? Handicapped Accessible:
or� — o
Rides: ❑ How many? Type:
t�
Land Clearing or ❑ Yes ❑ No'RJ Describe:
Grading:
INSURANCE INFORMATION
Evidence of insurance must be provided no less than 15 days prior to event. "Mason County" at 411 North Fifth Street,
Shelton, WA 98584 must be named "additional insured." Minimum Limits as applicable: $1,000,000 Commercial General
Liability, $2,000,000 Liquor Liability, $500,000 Auto Liability. All limits and coverage may be adjusted to meet exposure
as determined by County Risk Manager. "Carnival, Circus or Like Enterprises"license/permit will not be issued until
insurance has been approved.
Mason County Risk Manager:
lone Siegler
411 North Fifth Street Phone: (360) 427-9670 ext. 423
Shelton, WA 98584 Fax: (360) 427-8437
Falsification and/or misrepresentation in completing this application may result in rate adjustment or event cancellation. I
UNDERSTAND THAT CHANGES TO THE ABOVE DETAILED PROGRAM REQUIRE IMMEDIATE NOTIFICATION TO
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT.
I,the undersigned representative, have read the "Carnival, Circus or like Enterprises Application"and the
Policies and Procedures contained herein, and I am duly authorized by the event organization/business to submit
this application on its behalf. The information is complete and accurate.
PRINT APPLICANT'S NAME: A e57
SIGNATURE OF APPLICANT:
SIGNATURE OF PROPERTY OWNER ( IF DIFFERENT THAN APPLICANT):
DATE OF APPLICATION: FEE AMOUNT COLLECTED:
APPROVED BY: DATE OF APPROVAL:
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