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Home My WebLink AboutEVE2008-00001 - PAR Application - 7/23/2008 AM MASON COUNTY FIRE MARSHAL Mason County Bldg.III 426 W Cedar St PO BOX 186 Shelton,WA 98584 (360)427-9670 Ext.273 Q r— �IF/lJ*I-S A,A, ✓s �4,)6 r-4X,r46 t Fib/Q� CODE ENFORCEMENT F(RE INSPECTIONS FIRE INVESTIGATION PUBLIC EDUCATION L63VA 7ALI-i-t'�-r'" O.MS L�k/ �a" `��' PRE-APP CHECK LIST ` EVE- Construction Type • Occupancy Type/Load A • Water Supply & Fire Hydrants • Fire Flow • Emergency Vehicle Access i� Lf. I-7-- G aD W i b E No Pi�i2>✓'i�G- ��T�e"� �,R/Z/o� ! 1v�4-'rNt3�SuR�i4t-�" Addressing C-A4X A7h'A' L el ToAA) /�'R�`'ri'��• (� Exits C,ocJSuJe- Byt7%x)6, fVcyN 7j-pn6�� S—FA067ilX- • AFA • Sprinkler System • Fixed Fi Suppression SystemviiQ ir P XaZ6Fi.QoY Fire Extinguishers :j-yj62- k qo- 3j gDdL /A) _3a� W A)& • Knox Box • Storage/Type/Height �� r2 ��vEz�4rv7 A�-noG�b' 7c i� y��1 ,4,<r �� Gas Meters/Tanks ,m prL�vt ' I r'• Other PREAPP: JULY 31, 2008 TIME: 1:15/1:30-2:30 Mason County Carnival Circus or Like Enterprises A pliCkfOA►v COUNTY p p 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: Av r-\/ Re,mai_45a/Ve.C: aol't Fe,,4 C5 Event Date(s): Auq 30-3 1 sr Day(s) of the Week: Saf Sun Time(s): /U,4,vj-!7 211 Event Address: y ti rl +P_ S1,G 4 Legal Description (TPN): Size of Property (if applicable): 5-. ,4 -c s Event Crowd Size: Participants: 300— Spectators: s"-10A Volunteers/Staff: 7S""-' Has event been held previously? No WYes ❑ If yes, what were the dates of the event&where? Any change from previous events? NoZ Yes ❑ If yes, please attach list of changes for this year's request. APPLICANT INFORMATION Applicant's Name: L c y l cr- C• T e-u f-1 I"er Applicant's Address: 70 E 6 r1-e n w001t IN . 4.46n &✓a Phone Home: 30-31 2T�•70 Work: Numbers: O(� Pager: Cellular: 2S3 RQ_S"�SS' Fax: Email: Owner's Name: -r e Pa;�Itq Owner's Address: Phone Numbers: Home: Cellular: Page 1 r 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, . Yes❑ Booths/Vendors: How many booths? How many vendors? Entertainment: Sound System: Describe, Accoustic ❑ Amplified , e�/ / 9 Food Will foodl be serypd or available? Will food be sold? No❑ YeslK No ❑ Yes If Yes, by whom? Water: Potable? Non-Po ? Electricity Source: Generators: How many? Size: Sanitary Facilities How mpny? Handicapped Accessible: Rides: ❑ How many? Type: Land Clearing or ❑ Yes ❑ No V 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: AC S� C' F ryrnr�?e.n SIGNATURE OF APPLICANT: SIGNATURE OF PROPERTY OWNER ( IF DIFFERENT THAN APPLICANT): DATE OF APPLICATION: 7A)-1 DA FEE AMOUNT COLLECTED: APPROVED BY: rr DATE OF APPROVAL: Page 2 1 Mending Area Stage - ® Exhibition Are,-i Concessions ® Sanitation 40 ® Mason County ` • Concourse ! YIP& Emergency #� Parking - 1 .. Af F i w ryr r Wpm 40 cNQ � w n •r• a Enter/Est . fit• �'� � i►-u. i Parking Area dft k a I� '� r r•i �� k±