20100042 Permit Pkg 031010City of Yelm
Community Development Department
Building Division
Phone: (380) 458-8407
Fax: (380) 458-3144
Applicant
Permit No.: 20100042
Issue Date: 3N 0/2010
(Work must be started within 180 days)
Name: YELM EAGLES Phone: 360-446-1453
Address: 2120 MILWAUKEE WAY
TACOMA WA 98421
Property Information:
Site Address: 1109 YELM AVE E Owner: SAFEWAY #1619
Assessor Parcel No.: 85810000100 Subdivision: N/A Lot: N/A
Contractor Information:
Name: YELM EAGLES Phone:
Address: YELM EAGLES
2120 MILWAUKEE WAY
TACOMA WA 98421
Contractor License No.: Expires: 0/00/0000
Project Information:
Project: FIRE WORKS
Description of Work: FIREWORKS BOOTH IN SAFEWAY #1619 PARKING LOT JUNE 28 THRU JULY 5, 2010
Sq. Ft. per floor: Heat Type (Electric
Other):
Gas
First ,
,
Second
Third
Garage
Basement
Fees:
Item
FIRE
I certify that I hav
to be true and co
Yelm regulations
easements and n
registered in
Contractor
YELM EAGLES
TOTAL FEES:
~lication and know the same
with all applicable City of
Fees
5 35.00
E 35.00
Fi~o~~/ ~ ~ ~~~ ~ l y'
Ci ~~ of Yelp
`~~ ~ ~:;0-R4G~
~L~~~t: 00023F17 3/10/010 4:~ FM
~:~rK: C7 TERM: 001
r,r~` ~ ~ o-~~
'i7 ~rtL
_'~'~~ ~~.0000 HUILDIMG PERMITS
~'O1GOC;y;? 35.OOCR
110'j YE ~M AVE E
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r
APPLICATION 2-OIO("~~yZ
FOR RETAIL FIREWORKS STAND PERMIT
WWM7105
TO: Governing body of city, town, or county in which DATE OF JAN.02, 2010
fireworks stand will be located. APPLICATION:
Applicant Name: Address, City, State:
YELM EAGLES 2120 MILWAUKEE WAY, TACOMA„ WA 98421
Sponsor (If other than applicant): Address, City, State:
RODNEY ROSSMAIER 2120 MILWAUKEE WAY, TACOMA„ WA 98421
Location of proposed fireworks stand: [Enclose drawing of stand location)
1109 YELM AVE YELM, WA SAFEWAY #1619
Manner and place of storage prior, during, and after sales dates:
ON SITE WITH SECURITY
State Licensed Fireworks Supplier:
American Promotional Events NW 2120 Milwaukee Way, Tacoma, WA 98421
FIREWORKS STAND PERMIT
For The Fireworks Sales Year Of: 2010
(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 permit from
CITY OF YELM the local governing authority, the named person, firm or organization is hereby
authorized to sell U.N. 0336 1.4G Consumer fireworks at the location designated herein between the
following date and times:
Sales For July 4ch
From: ~~~~~~,ZQ~ From:
To:
Sales For December 31Sr
To:
Sponsor: YELM EAGLES
Location:
Signature of Official Granting Permit
f Applicant
Agency: t!~.J~~, ~c ~ ~~~
Date: 3 ~ Permit Number: 7_ c~ / [~ v o S! z
Licensee Name: YEL~1 1:AGLI~S License Number: ~-15~
31)IXL4'1FU13 (Rn•.JD51 ~ MAR 0 ~ 2010
Washington State Patrol
Fire Protection Bureau
Office Of The State Fire Marshal
Washington State Fireworks License
Licensee Information
Yelm Eagles
2120 Milwaukee Way
Tacoma, WA 98421
License Number: WSPFL-00453
Stand Information
Contact Person: Rodney Rossmaier
Phone Number: (360) 894-2838
County: Thurston
Stand Number: SN-04777
Date of Expiration Date of Issue
January 31, 2011 February 24, 2010
Stand Location:
/Stand Location To Be Completed By Licensee)
3000-420-012 (R 9105)
~ v.~ (~n~ lOS
11045
Fireworks Stand License
License is Non-Transferable and Valid for Only One Stand
~' ~ ~~
State Fire Marshal Signature
Detach this wallet card and carry with you for
verification of certification.
Wasbington State Patrol 1 1 0 4 5
Fire Protection Bureau
Office Of The State Fire Marshal
ANNUAL FIREWORKS STAND LICENSE
Licensee: Yelnt Eagles
Contact Person: Rodney Rossmaier
License Number: WSPFL-00453
Stand Number: SN-04777 ~Yalid For One Stand)
Date of E:piration: January 31, 2011
Locatioa•
[Stand Location To Be Completed By Licensee)
~~/O.~
State Fire Mazshal Signattue Licensee Signattue
ACORD~, CERTIFICATE OF INSURANCE ISSUE DATE
11,oti2009
PRODUCER This certificate is issued as a matter of information only and confers no rights
MCGRIFF, SEIBELS & WILLIAMS, INC . upon the Certificate Holder. This Certificate does not amend, extend or alter the
P
O
Box 10265 coverage afforded by the policies below.
.
.
Birmingham, AL 35202
800-476-2211 COMPANIES AFFORDING COVERAGE
ComApany Columbia Casualty Company
INSURED Company
American Promotional Events, Inc. B
dba TNT Fireworks
PO. Box 1318 Company
Florence, AL 35631 C
Company
D
Company
E
This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding
any requirement, term or condition of con tract 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, conditions and exGusions of such policies. Limits shown may have been reduced by paid claims.
CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY
LT EXPIRATION
A GENERAL LIABILITY 4015727097 11/01/2009 EACH OCCURRENCE $ 1,000,000
® Commerdal General Liability 11/01/2010 FIRE DAMAGE $ 100.000
^ Claims Made ®Occunence
^ Owners' end ContreUOrs' Protection
MEDICAL EXPENSE
$ EXCLUDED
^ PERS. AND ADVERTISING INJURY $ 1,000,000
^ GENERAL AGGREGATE $ 2,000,000
General Aggregate Umd applies per: PRODUCTS AND COMP. OPER. AGG. $ 2,000,000
^ Pdiq ®Project ^Ltxxtion
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
^AnyAutomobite $
BODILY INJURY Per arson
^ All Owned Automobiles
$
^ Scheduled Automobiles BODILY INJURY Per accident
^ Hired Automobiles PROPERTY DAMAGE Per accident $
^ Non-owned Automobeas COMPREHENSIVE
^ COLLISION
WORKERS' COMPENSATION WC Statuto Limit Other
AND EMPLOYERS' LIABILITY EL EACH ACCIDENT $
EL DISEASE Each em to ee $
EL DISEASE Polic Limit $ ~
EXCESS LIABILITY EACH OCCURRENCE $
^ Occurrence ^Claims Made AGGREGATE $
This certificate only applies to Re: Safeway located at 1109 Yelm Ave E in Yelm, WA (loc #WWM7105);.
The Certificate Holder is named as Additional Insured with respect to General Liability as required by written contract subject to policy terms, conditions, and
exGusions.
CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Yelm Eagles
Safeway Authorized Representative
City of Yelm
PO Box 479
Yelm, WA 98597
_-~';~4a.P .. ~s, ~~
Page 1 of 1 CerllficatelD# OWH04BTS
Far f ror.+
To whom it may conccrn-
Please be advised that Mr. Van Phillips/V4'II7 Unlimited, has a license to conduct
5re«•orks sales at the Safeway store locations listed on the attached exhibit.
Sa!
B ~.
Its
By
Its
1/Z/2010
yVID Unlimited
N 7803 Market St Spolkane Wa 99217 509-931809 F'ax 509-467-1360
To Whom It May Concern:
TNT Fireworks, Inc. has been granted the exclusive rights to license, erect, and
maintain fireworks stands/tents on Safeway, Inc. store parking areas for the
2ozo fireworks season.
.~ ~_
l
~`~ ~
~\'~.
Van Phillips
January ~, 2oio
Location # Location Name Address Line 1 Cit ST Season Owner Contact Name
WCH3651 SAFEWAY #1593 610 WINE COUNTRY RD GRANDVIEW WA 2010 WID UNLIMITED
WCS1650 SAFEWAY #3521 510 GRANT RD EAST WENATCHEE WA 2010 WID UNLIMITED
WCS2299 SAFEWAY #1544 1150 BASIN SW EPHRATA WA 2010 WID UNLIMITED
WEH5250 SAFEWAY #1016 430 SE BISHOP BLVD PULLMAN WA 2010 WID UNLIMITED
WEH5751 SAFEWAY #385 391 N MAIN COLVILLE WA 2010 WID UNLIMITED
WWB1550 ~ SAFEWAY #1472 525 E COLLEGE WAY MOUNT VERNON WA 2010 WID UNLIMITED
WWB4150 SAFEWAY #531 101 AUBURN WAY AUBURN WA 2010 WID UNLIMITED
WWH2155 ~ SAFEWAY #535 20711 BOTHELL-EVERETT BOTHELL WA 2010 WID UNLIMITED
WWH2159 SAFEWAY -SILVER FIRS 5802 134TH PL SE EVERETT WA 2010 WID UNLIMITED
WWH3062 - SAFEWAY - KINGSGATE 14444 - 124TH AVE NE KIRKLAND WA 2010 WID UNLIMITED
WWH3150 ~ SAFEWAY #395 18221 BOTHELL WAY NE BOTHELL WA 2010 WID UNLIMITED
WWH4250 - SAFEWAY #494 152 ROOSEVELT AVE E ENUMCLAW WA 2010 WID UNLIMITED
WWH4552 - SAFEWAY #459 20830 - 108TH ST KENT WA 2010 WID UNLIMITED
WWH4701 SAFEWAY HWY 410 BONNEY LAKE WA 2010 WID UNLIMITED ~
WWH4750 - SAFEWAY #545 6400 MERIDIAN MILTON WA 2010 WID UNLIMITED
WWH5751 SAFEWAY #362 938 N CALLOW BREMERTON WA 2010 WID UNLIMITED
WWH6352 SAFEWAY #639 110E 3RD ST PORT ANGELES WA 2010 WID UNLIMITED
WWH6355 SAFEWAY #1922 2709 E HWY 101 PORT ANGELES WA 2010 WID UNLIMITED
WWH7050 SAFEWAY 4280 MARTIN WAY E OLYMPIA WA 2010 WID UNLIMITED
WWH7354 SAFEWAY #1464 3215 HARRISON BLVD NW OLYMPIA WA 2010 WID UNLIMITED
WWH7752 SAFEWAY 221 W HERON ST ABERDEEN WA 2010 WID UNLIMITED
WWM7105 SAFEWAY #1619 1109 YELM AVE E YELM WA 2010 WID UNLIMITED
WWT2156 SAFEWAY#534 3532 172ND NE ARLINGTON WA 2010 WID UNLIMITED
WWT2161 SAFEWAY #523 14826 HWY 99 N LYNNWOOD WA 2010 WID UNLIMITED
WWT2262 SAFEWAY #1522 20500 OLYMPIC PL ARLINGTON WA 2010 WID UNLIMITED
WWT2357 SAFEWAY 19651 HWY 2 MONROE WA 2010 WID UNLIMITED '
WWT4059 SAFEWAY 13101 SE KENT KANGLEY RD KENT WA 2010 WID UNLIMITED
WWT4648 SAFEWAY #1798 11501 CANYON RD E PUYALLUP WA 2010 WID UNLIMITED
WWT4657 SAFEWAY #547 10105 - 224TH ST GRAHAM WA 2010 WID UNLIMITED
WWT4662 SAFEWAY #1436 1624 72ND ST E TACOMA WA 2010 WID UNLIMITED
WWT4687 SAFEWAY (NEW 13308 MERIDIAN E PUYALLUP WA 2010 WID UNLIMITED
WWT5250 SAFEWAY #541 4831 POINT FOSDICK DR NW GIG HARBOR WA 2010 WID UNLIMITED
WWT5754 SAFEWAY #1524 1401 NE MCWILLIAMS BREMERTON WA 2010 WID UNLIMITED