20100048 Permit Pkg 031210City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Applicant
Name: AMERICAN PROMOTIONAL EVENTS NW
YELM JESUS NAME PENTECOSTAL
Address: 2120 MILWAUKEE WAY
TACOMA WA 98421
Permit No.: 20100048
Issue Date: 3/12/2010
(Work must be started within 180 days)
Phone: 253-922-0800
Property Information:
Site Address: 17100 STATE RT 507 SE Owner. WALMART
Assessor Parcel No.: Subdivision: Lot:
Contractor Information
Name: AMERICAN PROMOTIONAL EVENTS NW
Address: BRENDA MERRITT
2120 MILWAUKEE WAY
TACOMA WA 98421
ConVactor License No.:
Phone:
Expires: 0/00/0000
Project Information:
Project: FIRE WORKS
Description of Work: JUNE 28, 2010 THRU JULY 5, 2010
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor Fees
FIRE AMERICAN PROMOTIONAL EVENTS NW $ 30.00
TOTAL FEES: $ 30.00
Applicant's Affidavit:
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all appligble City of
Yelm reg lations incl ding those governing zoning and land subdivision, and in addition, all covenants,
easeme a d re ricU ns of record. If applying as a contractor, I further certify that I am currently
register rn e S fe Washin t
Si nature Date
Firrn ~ t~
Sets of Prints:
final Inspection:
Oate:
City of Yalm
%;;f~:~ 418-840L
RECD: O(~~3r~!'a0 3I12I~010 x:38 PM
OF`ER: GO TERM: 001
REFS: 300017, i
TRAM: 33.OOt30 I~UILDING F'ER~iITS
0100048 ;,O.000k
R~kICAN PRO~iOTI EVENTS NW
17100 STATE RT 507 SE
FIf~ 30.0008
TEI~.R"tD: 30.00 CtfCK
APF'i IED: 30.00-
APPLICATION
FOR RETAIL FIREWORKS STAND PERMIT
WWT7150
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 JESUS NAME 2120 MILWAUKEE WAY, TACOMA„ WA 98421
PENTECOSTAL
Sponsor (If other than applicant): Address, City, State:
GREG MATTOCKS 2120 MILWAUKEE WAY, TACOMA„ WA 98421
Location of proposed fireworks stand: (Enclose drawing of stand location)
17100 STATE RT 507 SE YELM, WA WALMART
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 4th Sales For December 31"
From:
To:
From:
To:
Sponsor: _YELM JESUS NAME PENTECOSTAL
- /s/ 6~(~w.c~a~t7~~ FOR GREG MATTOCKS
ial Granting Perniit Signature of Applicant
Title: ~ Agency: • ~ -'
Dare: 3 Permit Number:
Licensee Name: YELM JESUS NAME PENTECOSTAL License
3000-42U-013 (Rev 2lOS)
MAR 1 2 201U
BY: ------•-------------
Washington State Patrol
Fi
P ~ ~ ~ ~•'~ 10 9 9 7
re
rotection Bureau
OfGceUfTheStateFireMarshal Fireworks Stand License
Washin ton State Fireworks License
Licensee Information License rs 1Von-Transjerable and valid jot Only One Stand
Yelm Jesus Name Pentecostal Church
2120 Milwaukee Way ,,~~, ~~~~ d
mow[`
Tacoma, WA 98421 License Number: WSPFL-01235 State Fire Marshal Signature
Detach this wallet card and carry with you for
Stand Information verification of cettification.
- - _ _ _ . _ __ _ _ _ _
Contact Person: Greg Mattocks Washington State Patrol 10 9 9 7
Fi
Phone Number: (360) 400-1588 re Protection Bureau
Office Of The State Fire Marshal
County: Thurston Date of Expiratiotl Dat e of Issue ANNUAL FIREWORKS STAND LICENSE
Licensee: Yelm Jesus Name Pentecostal Church
Stand Number: SN-04729 January 31, 2011 February 24, 2010 Contact Person: Greg Mattocks
License Number: WSPFL-01235
Stand Number: SN-04729 (Valid For One Stand)
Stand Location: Date of Expiration: January 3l, 2011
Locat;on:
[Stand Location To Be Completed By Licensee) [Smnd Location To Be Completed By Licensee)
3000-420-012 (R 9/05)
State Fire Marshal Signature Licensee Signature
C'-~~
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March 10, 2010
Gary Carlson
Building Dept.
City of Yelm
PO Box 479
Yelm, WA 98597
Dear Building Dept.,
In preparation for the upcoming 2010 July season, please find enclosed with
this letter all information to apply for 1 temporary retail fireworks stand permit.
I have also enclosed 1 check, totaling $30.00, check # 30001769, for the
Permit Fee of $30.00.
If you have any questions or require further information please feel free to
contact me at (253) 922-0800.
Thank you for your time and attention to this matter.
Sincerely,
Brenda Merritt
Licensing & Permits
American Promotional Events, Inc. -Northwest
Enclosure(s)
AMERICAN PROMOTIONAL EVENTS, INC.
2120 MILWAUKEE WAY • TACOMA, WA 98421 D ~ ~ ~ ~ ~ n i,l
TACOMA (253) 922-0800 • SEATTLE (253) 838-1099 L~ L~r ~f
FAX (253) 830-2930 t~QR 1 Z ZD~I~
www,tntfi reworks.com
B Y:
ISSUE DATE
CERTIFICATE OF INSURANCE ,,,
ACORD
0009
ry
PRODUCER This certficate is issued as a matter of information only and confers no rights
MCGRIFF, SEIBELS 8 WILLIAMS, INC. upon the Certificate Holder. This Certificate does not amend, extend or alter the
PO Box 10265 coverage afforded by the policies below,
Birmingham. AL 35202
g00-476-2211 COMPANIES AFFORDING COVERAGE
Company Columbia Casualty Company
A
INSURED Company
American Promotional Events, Inc. B
dba TNT Fireworks
P.O. 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 contract or other document with respect to which this certifipte may be issued or may pertain, the insurance afforded by
the policies described herein is subject to all the terms, conditions and exclusions of such policies. Limits shown may have been reduced by paid Gaims.
CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY
LT EXPIRATION
A GENERAL LWBILITY 4015727097 11/01/2009 EACH OCCURRENCE $ 1,000.000 j
® Comnreraa General L~ab~ity 11/01!2010 FIRE DAMAGE $ 100,000
^~"`AfiOa ®OOLJA°fOB
e'
iM C
^ O
' P MEDICAL EXPENSE $ EXCLUDED
rotection
rwrsr
a
onlraUOrs
^
PERS. AND ADVERTISING INJURY
$ 1,000,000
^ GENERAL AGGREGATE $ 2,000,000
Genarel Ag{rregate urrot apWies Per: PRODUCTS AND COMP. OPER. AGG. $ 2,000,000
O Pdicy ®Prgect ^Location
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
^^"Y"11O"1ObNe BODILYINJ RY Per n $
^ All Owned AUlonpbiles
n
d
l
d A
^ s
BODILY INJ RY r CCi ent
$
c
a
u
o
ulomobdes $
^ Hved Automobiles PROPERTY DAMAGE Per accident
^ Non-owned Aubmodles COMPREHENSIVE
^ COLLISION
WORKERS' COMPENSATION WC Statuto Lim' Other
AND EMPLOYERS' LIABILITY EL EACH ACCIDENT $
EL DISEA E Each em I $ ,
El DISEASE PoG Limit $ ~
EXCESS LIABILITY EACH OCCURRENCE $
^ Octvnence ^Claxns Made AGGREGATE $
$
This certificate only applies to Re: WalMart located at 17100 St Rt 507 SE in Yelm, WA (loc #WWT7150);.
The Certificate Holder is named as Additional Insured with respect to General Liability as required by written contract subject to policy terms, conditions, and
exclusions.
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 Jesus Name Pentecostal
WalMart Authorized Representative
City of Yelm -
PO Box 479 ~ i
'
~`
~
Yelm. WA 98597 .. ,-.-~ s• - -
~ ter
~~•-
Walmart ;;;
Save momly. lfw bettK.
702 SVN Bth Street
Bentonvtlle, AR 72718
Fax d79 204.2263
wanv walmartCCxn
New Business Development
Andre' J. Tucker, Senior Manager
To Whom It May Concern
American Promotional Events, Inc. dba TNT®Fireworks is an approved National Supplier for 2010 to
conduct f~eworks sales on our stores' parking lots where tfiis type of promotion is legal. Events
usually run 7 to 10 days with set up beginning approximately 5 days prior to the event.
An American Promotional Events, Inc. dba TNT® Fireworks representative will call you to introduce
the company and discuss your participation in the event. Participation In this event is not mandatory
but does add additional income to your bottom line profits, The Store Manager must approve the
store's participation and placement on the parking lot by store stamping the PreSale Survey. Then,
Other Income will send an ema~ to the store verifying approval. TNT® Fireworks is responsible for
obtaining all necessary permits and/or Hcenses and must display such permits and/or licenses at
each location
Thank you in advance for your cooperation in this matter and if you have any questions, please
contact New Business Development at (479) 273-4516.
Best Regards,
~ ~~
Andre' J. Tucker
Wal-Mart Stores, Inc.
SITE DIAGRAM
Date Drawn: March 17, 2008
Address: 17100 State Route 507 SE
Store/Center: Wal-Mart Superstore
City & State: Yelm, Washington ~~j~~
Cross Streets:
GPS Co-ordinates
46.56.003 N
122.37.725 W
Entrance
d
i
~i
c;
9i ~
,
i ~
i ~
d
~~
i~
=a
uyne r~a,se
i
U9M . ....._..~
Loc No: WWT~ 150
Ordinance of: City of Yelm
Parcei No:
Tent Faces Direction of: Open To The North
Tent Size: 20 x 40
Notes: DO NOT STAKE TENT -WATER BARRELS
OR CEMENT BLOCKS ONLY
- - - - - -- -
Tfre & tube
Main Entrance Grocery
Garden Center Wal-Mart
iso~+
~ i
~ 30
HWY 507
~~
Open Fleld
TNT 40 X 20 Tent Layout
~;~.
7 ~ ~_. Exit 5'6"
s
~* 4
,~,
L
~ 6'
c
~ ~
o
U 4,6„ ~; W
9
L- -~ ~ 7 12
in
.~
W
Pallet Cash
Display
Entrance 8'
~~~'yo~3 = 8' Table
= 6' Table ®=Fire Extinguisher
i 4~
~erri~u~rte of a~~e ~e~i~~~~ce
. r
•~ ~ REGISTERED Issues er i z- z o-~ 5
~~ Y Daf~
t: Fabric No.
~ t•l e t i d l a n ti A n u f a c C u r i n g manvfadur~d
„v SOSU l'ctpler Avc., Ste. 143).
rT~ , F"-308.01 Mrntptria, TK 78157
this is fo certify Ihot fha ma}6rials described on the reverse side hereof hors been flame_
rel'ardanf frealed (or are inherently nonAammoble).
ppR Key Ma nuEaccur ing b Rental /~ppREsS 5x30 fipckdal. •St . Nl;
CITY Brooks STATIF o R _.`
CertiFiccfion Is hart-cy mod. thafr (Check''o" or "b"J
.a (a) T}~e articles deserit»d on the re~•rt• tide of this CerllRcot• hays boen treah~d wfih a floors-retardant
ih~tttical opprw+d and reQfsl•rrd by the State Fr. Morshol and that the nppiicatioa of said ehernlea(
was done in confortT+ance with tha laws of the Stah of California and the Rui•t and Reyulotions of
the State Fit• Marshal. '
Nome of chsmioal us.d............._..... ......................................._.........Ch.-n. Rio. No...............---.......
Method of application....~.........._........_._....._~_...._ ..................~...........__....._._........._..._.............
D (b) The attldes d+svibid an tl+. r+r.rs. sld+ hK+o'f ar+ n+od+ fTOeti o flet++~tetifstent fabric or mor.riot
r.plat+t+d and app.va~d by th• Stbfe Hro Morshol ~+or e..ds trs-.
Trod. same of fllottt.-resisraet fabric .. _. Group I .................... Na,.Mt tiev5..,._.,
The F~afne Retardant Process Used_.~ i..~.~_ .t~Q.S...... Be Removed 8y Washing
t.at ...ral ...e
1IHt{LE ROBERTSON
N•ae el AHli.•e.r w Ml.ra7en s.rp..inl.n/..l
CONYROL NO 14 9 26
CUSTOMER ORDER No. 4 2 2 r
CUSTOMER INVOICE NO. 80222
YARDS OR QUANTITY 7 b 0 yards'
COLOR re d
BTYLF Apex II Chrome
CATS PROCESSED I- I I- 9 6
TnTOI p a~
~e~t~f u~te ~f ~m~e ~Re~.i~~~t~~e
$ 4
' ~~,~ REGISTEREd ISSUED 6Y
` Do-.~ I- 10-9 $
E Cr Fabric No. menufedur.d
Meridian ttanufacturiny,
'' "p-306.01 SOSu Poplar nvr-, ~~v.. ia~12
Rt~w4 Mc•mplt i s, TN SN I S 7
This is to certify that the maferlals described on the rorerse side hereof ha~o been flame-
rstvrdont treated (or are inherently nonf~ammabls).
FpR Kcy itartylacturing b kencal ADDRESS SU10 Hpt-kdajc St.NE _
CITY Brooks STLTE 0 R
Certfficotion is horaay made lhotr (Chock "a" or "b")
(a) The articles d•scribod on Ih• r.v.rse side of this Corfificat. have i~en treoted with aflame-retardant
chemical apprw.d and r.Qistered by th• Scot. Flr. Mar:hot and that th. applkation of said chemical
vrat doe,• in eortfortme+ne• Mrith lh• lows of th. State of California o~d the Rul.s.ond ReQulo-ioas of
th. Slat. Fl-. 1~Aars}eal.
Nam. of eh.eniea) us.d .....................__..................--•-- ......._._........._.Chem. Rep. No........... .. ...._....
JKethod of applicrstion ....................................._.-_......_..._......____........__.........._.......................
X (b) Th. amides d..atb.d on !M r~•rte sld• b.nid ars erode from o jlotr..-etislttant tobr=c a mot~~ial
regtsl.e.d and dpQrw+d by fh. Stole Flr. hAordw( f~,r vxfi w.
60b
Twde r-oea. of flornK.sktont fa6rlc .. ................C'.roup I ......... No. M t i
The Fame Retardant Process Used..-~ i.! ! .uo~ ~e Removed 6~ Washing
t•~lu e, ..ui ;,~.. .
Jimmie Rabcctson
eleee el ~pGe.-« M />1<eA~ sv...iW.I~.+
CONTROL
~z2~
CUSTOMER ORDER NO.
CUSTOMER INVOICE NO. 80221
YARDS OR QUANTITY ~ 5 0 yard s
COLOR uh i t e
S7YLE`~`Pe7 II tthlCe Ch come
bA7E F'ROC:ESSED I - 12 - 9 6