The URL can be used to link to this page

20190199 906 Yelm Ave E Fireworks StandCITY OF YELM COMMERCIAL BUILDING PERMIT APPLICATION FORM Project Address905 YehO Ave East Parcel #. 22730110204 Zoning; COMerCBil Current Use;Groce Store! Proposed Use -,Consumer Firms ❑ New Construction • ❑ Re -Model / Re -Roof / Tenant Improvement ❑ Plumbing 0 Mechanical 0 Fire Prevent/Suppress/Alarm ® Other Project Description/Scope-of 1Alcrk: Retail sales of 1.4 G Consumer Fireworks Class C Project Value: NA Building Area (sq. ft) Parking GarageN/A_ 1" FloorLSOU 2nd FloorN/A 3" FlooQN/A Building Height N/A Are there any environmentally sensitive areas located on the parcel? no If yes, a completed environmental checklist must accompany permit application. BUILDING OWNERITENANT NAME: Yelm HaZa LLL., 1 tafeat vvau riupwi tmig ii rt;. ADDRESS 18230 East Valley Hwy. EMAIL HA CITY Kent STATEWA _ZiP9ifi137_ TELEPHONE 1 -42R -987..f1049 XDDRESS --- EMAIL CITY STATE ZIP TELEF GENERAL CONTRACTOR NA TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # PLUMBING CONTRACTOR,NA TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATA CITY LICENSE # MECHANICAL CONTRACTOR NA TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE 11 Copy of City Mitigation documentation (TFC). 1 hereby cettiry that the above information Is correct and that the construction on, and the occupancy and the use of the above described properly will he In accordance with the laws, rules and regulations of the State of Washington and the City of Appiftuantfs Signature Date Owner 1 Contractorl Owner's Agent / Contractor's Agent I Tenant (Please circle one.) All permits are non4ransferable and will expire if work authorized by such permit is not begun within 180 days of Issuance, or If work is suspended or abandoned for a period of 180 days 1051'e1m Aeenae {Vest PO Dor 479 yelm, 1VA 58597 (360) 458.3835 (360) ,158-3144 FAX wtnm.c4ehnavame THIS FORM IS INTENDEDFOR"tMEDYliOGAL-AtRTM TIES igAVING JURISDICTION (AHJ) IN THE EVENT THEY DO NOT HAVE A PERMIT FORM SPECIFIC FOR RETAIL FiNEWDRKS SALMATA =WSUME1R FIREWORKS RETAIL SALES (CFRS) FACILITY. I T IS NOTMEAN T TO CE REQUIRED IN ADLNTIONTD DRomEticFAli iva4i PER4f hiG FORM AND/OR PROCESS THAT MAY EXIST WI FH THE LOCAL ANJ. nirceliom: Provided lilt local jurlsdle*mlus nopermlf fermcT4la3ro n, complete lilts peresiil application and sulnn)t It witli file local A11J portion oryour Retail Flrcuorks Stand Licam Iotbc1urbdictioa is s hkiiyna 1ds1110 run;'aur CHIS racillb-, WASHINGTON STATE FIREWORKS 'RETAIL SALES PERMIT APPLICATION Anlallcant Information ❑ NeW/First Time Applicant W1 Previous Permit Holder Hitchner, Cnrla A Name of Group, Orgarl=len.ar PAcum (Lat;t ,filraL Middle Initial) Issued the Fireworks Retailer License Hitchner, Carla A Name of Permit Applicant {Last, First, Mtddlo Initial) PO Box 298; Mckellna, WA 98558 Pormll Applicant Mailing Address (Complete Including Streel, City, State, and ZIP Code) ( 253 ) 431.1671 carlahitcllner@yayoo.com Phone Numbar E -Mail Address Local Business Numbor(If roqulred) CFRS Facility Information ;❑ Stand _0 Tent Other: Size: i 600s f 111Ox40 Specify Square FeetfUlmensions 906 Algiers Drive NE; Yclm, WA 98597 CFRS Fac Illy Address (Complete lnelurllng Sirest; City, State. and ZIP Code) Yelm Plaza LLC ) 22730110204 Name of Property owner orAulilortud Representative Phone Number Parcel Numbar for Stand Local)on Fireworks Supplier infortriatl2gList vffuf the licensed fireworks wholesalers who will be supplying this stand product Winco Fireworks Storage Information E] on Site ❑ Off Site: _ _ storage Address lComplate Including Street, City, slate, and IIP Code) Sales Structure ❑ Detached Building ❑ Truck/Trailer ❑ Other: S eclf CHECKLIST FOR SUBMISSION Check with the local AHJ for all applicable submission dates and deadlines: ❑ ApplicationlPormlt Fee ❑ Insurance Certificate ($9,000,000) ❑ Clean -Up Bond Fee (if applicable) ❑ Valid Washington State Fireworks Retailer License ❑ Property Owners Written Permission ❑ Detailed Site Plan ❑ Interior Plan (required for tents and 'other" facilities) I hereby certify the Information in this application is true and correct. I am aware of and agree to comply with all relevant provisions of law, rule, .and any ordinance of the stale of Washington and the city/county permitting this CFRS Facility. gnatur f Permit Appllcant Prinled Name of Permit Appilcant Dale of Signature FIRE CODE AUTHORITY- AVtI GOU SDICTION ❑ APPROVED ❑ DENIED . . . , .. Permll NumW proved By Date of Approval SEE BACK OF TNISfDRtA"RANY RESTRICTIONS, CONDITIONS, OR NOTATIONSbN THIS PERMIT ,e Signature of Permlift ,Dtfictal Printed Name and Title Date of Signalure THE FIREWORKS RETAILER'LiCENS'EH=ER(LfCENSEEj SHALL RETAIN THIS PERMIT WITH THE ASSOCIATED FIREWORKS RETAILER LICENSISAND MAKE THEM 6OTHAVA1LASLE FOR INSPECTION ATANY TIME THE STAND IS IN OPERATION 7000-420.017 (R 1110) Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE Viand Number: SN -12658 � Licensee Data Timelr)Llt Fireworks PO Box 5394. Spalla*ay, VVA 9E�387 License Number: VVSPFL-0' Phone %nihe-r: c253)431-1 it 1 Operational Data Wholesaler: VVinco Fireworks Utah LLC County ofa E inn: Thurston aper 'Fi7r: Limp e Stand Operated By: Car�tchner Date of Issue -February 19. 20119 Date of Expiration: January 31, 2023 Consumer Fireworks Retailer Licenses issuer! after May are ONLY valid for New Years Sales with.j I It a prm i; froda a focal fire code officiallauthority heti i:ia jurisdiction. This license allows fJr . peralion c .a s'irl;a [);:attonlstand for retail }ales ,o -he public of state legal consumer f♦rewory;; weir.-"i:,sed onl,; from a licensed firewt)'ks whalesa'er. ?:115 LIC ENS E PORTION ACCOMPANIES Yk_ UR LOCAL PErn,AIT'APPLICA.T[ON 'CRY OF YELL I JOFFMAL WE ONLY 905 Ydm Ave. W. FEE $35.00 Yelm, WA 98697 WY carom Dov, dopt. Y3W)46"497 OFFICE 1Vde Dop,. ,436446&4346 FAX www.cl,yeIM + [nip, Ditto l#c, No. APPLICATION FOR BUSINESS LICENSE Upon recelpt oifhel7oer+eeepp anand;85.a0 payor@�lite Ci(y of Yelm W11 condual an Irispocllon of the prem11e0e far10&g:andJkaLv bwnTormaace. Upon approval from lite Yalm 13ulldfng I7epadniant of sold promisek-the C1tyC19d(s fffceWil pmcese the appllcalion and mail 11canse to applicant at oddross listed Wow. Appllmdonfsheraby made fora Business License for the City of Yehn ® NEW UMMt MS . NAME CHANOWMAILING ADDRESS CHANGE ONLY DATE BUSINESS NAME 71maaut FIrmorke NATURE OFM%WEW_-S9Nvwl RQUI BUSINESS LWATMAnDRESS Atglers Drive NE MAILING ADDRM PO BOX 288 Mokenna WA 98668 EMAIL ADDRi"55, CariehllclinarYahov.com F ANTICIPATED OPENINODATE dune 28, 2019 DAYS & HOURS OF OPERATION _ 7 days from Cam -1022 OWNER(S) Carle H11oliner Addro!ia PO 13OX 290 McKenna WA 08556 TELEPHONE: 2534314671 city 81010 ZII) (OUB") (NontelEmergancy) CONTRACTORWREGISTRATIONDEo. (Ef appRcetrla) THURSTON CO: NEWHAPPROVAL %M _ STATE OF WASHINGTONititASTERBUISINWS LICENSE NO. (USI) 8ignalure Date 1-9-3-M DATE AC"R" CERTIFICATE OF LIABILITY INSURANCE 1211312�1�°"YYY' THIS CERTIFICATE IS ISSUED AS A 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(les) 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 Britton Gallagher One Cleveland Center, Floor 30 1375 East 9th Street Cleveland OH 44114 PHONE INSURED INSURER B: Winco Fireworks Utah LLC INSURER C: 710 Amidan Drive INSURER D: Ogden UT 84404 INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER: 1988572543 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 CONTRACT OR 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL U POLICY EFF POLICY EXP-- ILTR TYPE OF INSURANCE 1 POLICY NUMBER RMUD DIYYWY LIMITS A GENERAL LIABILITY SIBGLO1234-181 12/15/2018 12/31/2019 EACH OCCURRENCE $1.000,000 X COMMERCIAL GENERAL LIABILITY PREMIE RENTED $500-001D CLAIMS -MADE � OCCUR MED EXP (Ar,y one person) $ PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea accidenINEL"t ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS A as I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTIONS $ STATU- WORKERS COMPENSATION OR ES_ AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE F__1N/A E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L- DISEASE --EA EMPLOYE $ If yes, describe under -POLICY LIMIT $ DESCRIPTION OF OPERATIONS betaw E.L DISEASE DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) *"For premise liability — this certificate reflects coverage for the dates and location noted below only.** **For product liability — this certificate reflects coverage for product purchased from the above referenced named insured Only*" Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Dates of Coverage for Christmas/New Year Season: 12/28/18 through 12/31/18 Dates of Coverage for 4th of July Season: 06/28/19 through 07/04/19 See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Yelm THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 479 ACCORDANCE WITH THE POLICY PROVISIONS. Yelm WA 98597 AUTHORIZED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: A`C>RV ADDITIONAL REMARKS SCHEDULE Page 1 of 1 NAMEDINSURED AGENCY Winco Fireworks Utah LLC Britton Gallagher 710 Amidan Drive POLICY NUMBER Ogden UT 84404 CARRIER I NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Stand Location: 906 Algiers Drive Yelm, WA 98597 Stand Operator: Carla Hitchner Landowner: Yelm Plaza, LLC Additional Insured: The City of Yelm and all its employees; Thunder Fireworks Inc.; Seven One Seven Ind. LLC; Yelm Plaza, LLC. n, -inna Ae nian MRaORATION. All rights reserved. ACORD 101 (2008/D1) - The ACORD name and logo are registered marks of ACORD A �► J Z4 F4C V �• V ' As yi Certificate of Flame Desistance Registered No. FA ISSUED BY Tacoma Tent & Awning hAannfo rfnrc i rhta 6/19!2008 -4".)l Tacoma, Washington (253) 627-4128 This is to certify that the materials described below have been flame retardant treated (or are inherently nonflammable). For: ANNA'S PARTY RENTAL Address1: 7710 Waller Rd. E. Address2: City: Tacoma State, Zip: WA 98443 - Certification is hereby made that: (Check "a" or "b") F_ (a) The articles described below have been treated with a flame-retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in conformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Name of Chemical Method of Application Chem. Registered No. r f li> The articles described below are made from a flame -resistant fabric or material registered and approved by the State Fire Marshal for such use. Trade name of flame -resistant fabric Ferrari 502 FA -444.01 Registered No. The flame retardant process used will not be removed by washing. Tom Randles zy Name of Production Superintend Vice P - ent ;cription: . // 30'x 15' canopy mid section: Ferrari 502 translucent white vinyl. Ferrari 502 is certified to meet NFPA- standards. ial Numbers: 65308M n v i i i ■O n FIREwoRK&TEATT IZSE AGREEMENT THIS LEASE AGREEMENT ("Lzase Agteemeri }, made this day of 2018, between Yelm Plaza. LLC, hereinafter designated the "Land Owner" and Thunder Fireworks, Ine.,a Washiagwn corporation,„hereinafter designated the "Lessee.” WITNESSES: Thatthe said Land Owner "doesby these presents lease to Lessee the following: 1. PREMISES: 906 Algiers Drive North West, ( 906 Yehn Ave East) As per the diagram marked Exhibit "A". 2. TERM: June 15th to July 15th for the year of 2019 3. RENT: 4. SECURITY:I ND DAMAGE DEPOSIT: Waived. 5. SUBLET: Lessee stall riotassign this Lease Agreement or any part hereof without the prW w6tten consent ofLand Owner. 6. LESSEE'S OBLIGA-BONS: Lessee shalh (a) Assume:full liWft:for any and all claims, damages or causes of action arising dwing the term of this Lease Agreement caused by Lessee, it's agents, contractors, sub -contractors, guests and invitees, and hold Land Owner harmless there from. (b) Provide Land Owner -with evidence of liability insurance effective for the Term in an amount of not less the ten million dollars ($10,000,000.00) with a rider fisting Land Owner as an additional insured. Lessee will provide documentation to Land Owner showing the insurance coverage is active prior to the commencement of any use of the Premises for the term of the Lease. (c) Properly dispose of all rubbish, garbage and waste generated by Lessee, its agents, contractors, sub -contractors, guests and invitees, in a clean and sanitary manner. ',(d) Not restrict :the °flow of traffic (pedestrian / vehicular). (e) Comply with arty and all laws, rules, regulations and requirements imposed upon it by any governmental agency governing the Lessee's proposed use ofthe Premises sad .post any required performance bonds wah the local government. Any permits or licenses required of the undersigned Lessee shall be obtained by the Lessee prior to the commencement ofiffic Term o€this agmement. LEASE AGREEMENT—PAGE 1 (f) Not intentionally or negligently destroy, deface, damage, impair or Remove any part of the Premises, nor to permit any of it's agents, contractors, sub -contractors, guests and invitees or other persons acting under its control to do so. (g) Suffer no lien to arise or be files by any taxing authority or by any contractor, sub -contractor, or supplier or labor or materials used be Lessee or any other third party on the Premises; and, in the event any such lien or claim of lien is filed, cause the same to be satisfied or discharged in full within thirty (30) days following the filing thereof. 7. USE: Licensee will use the Premises to conduct retail sales of approved "I AG" or commonly known as Class "C" and/or Consumer Fireworks along with those activities attendant to that intended use. Lessee may place temporary striping or cones and a tent as necessary and erect appropriate signage and will remove the same at the end of the term. Lessee shall .� not use the Premises for any illegal purpose. Lessee agregs,to-conform to all state, county and municipal codes, statutes;'ordinances and regulations concerning the use and occupation of the Premises and to obtain the prior receipt of approval of authorities of competent jurisdiction for its intended use of the Premises with copies thereof to Land Owner. If the Lessee is unable to procure the necessary firework permits from the State of Washington, Thurston County or the City of Yelm to operate a fireworks tent on the above mentioned Premises then this Lease Agreement shall be null and void. 8. ALTERATIONS: Licensee accepts the Premises in its present conditions, "AS IS, WHERE IS, and with ALL FAULTS." Lessee agrees not to make alterations to the Premises without the prior written consent of the Land Owner. 9. SURRENDER: At the expiration of said term of this Lease Agreement Lessee will surrender the Premises to Land Owner in a condition equivalent to or better that when first made available to Licensee. Reasonable wear and tear acceptable. 10. ACCESS: Lessee will have unlimited access to the Premises during the term of the Lease at the entrance / exit shown on the attached Exhibit A. 11. TAXES: Land Owner shall be solely responsible for any taxes on the real property. Lessee shall be solely responsible for any taxes on its personal property and/or the conduct of its activities. 12. COSTS, ATTORNEY'S FEES AND VENUE: If, by reason of any default or breach on the part of either party in the performance of any of the provisions of this agreement, enforcement of any term of this Lease is sought, whether or not legal action is instituted, the losing party agrees to pay all reasonable costs and attorney's fees of the prevailing party in connection therewith. In the event any claim for personal injury, death, property damage, or other alleged liability is asserted against Land Owner arising from Lessee use of Premises during the Term of this Agreement. Lessee agrees to defend and hold Land Owner harmless of any such claim, including attorney's fees and legal LEASE AGREEMENT — PAGE 2 costs. It is agreed that the venue of any legal action brought under the terms of this agreement shall be Pierce County, State of Washington. 13. NOTICES: (a) Notices to Land Owner shall be delivered, personally or by certified mail, postage prepaid, addressed to Land Owner at: Yelm Plaza LLC 18230 East Valley Hwy Suite 108 Kent WA 98032 (b) Notices to Licensees shall be delivered, personally or by certified mail, postage prepaid, addressed to Licensees at: Thunder Fireworks, Inc PO Box 1504 Graham, WA 98338 Phone: 253.875.0700 14. EXECUTION: This instrument is signed in multiple identical copies, any one of which will suffice for legal purposes as an original. IN SIGNING THIS INSTUMENT EACH PARTY ACKNOWLEDGES AND REPRESENTS TO THE OTHER SIGNERS: (a) That the person signing has read the instrument in its entirety. (b) That the person signing this document has authority to do so and to bind his/her principal, understands that this instrument constitutes and important and binding legal contract, which fixes and determines certain legal and obligations of the persons signing it. (c) That no provision of this document can be changes by reference to any oral representations or agreements. IN WITNESS WHEREOF, the Lessee and Land Owner have each hereunto signed this instrument in duplicate the day and year first above written. iAND OWNER- By: Witness LEASE AGREEMENT — PAGE 3 LESSEE: