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20100060 Permit Pkg 040510City of Yelm Community Development Department Building Division Phone: (360)458-8407 Fax: (360)458-3144 Applicant: Name: AMERICAN PROMOTIONAL EVENTS NW Address: 2120 MILWAUKEE WAY TACOMA WA 98421 Property Information: Site Address: 905 VFI M AVF F Assessor Parcel No.: 22730121200 Subdivision: Contractor Information Name: AMERICAN PROMOTIONAL EVENTS NW Address: BRENDA MERRITT 2120 MILWAUKEE WAY TACOMA WA 98421 Contractor License No.: Project Information: Project: FIRE WORKS Permit No.: 2~ ~ 00 ~ 60 Issue Date: 4/05/2010 (Work must be started within 180 days) Phone: 253-922-0800 Owner: RITE AID Lot: Phone: Expires: 0/00/0000 Description of Work: FIREWORKS STAND PERMIT RELAY FOR LIFE - YELM TRANSPORTATION RITE AID PARKING LOG JULY 4TH THRU DECEMBER 31, 2010 Sq. Ft. per floor: First Second Third Garage Basement Fees: Item FIRE Heat Type (Electric, Gas, Other): Contractor AMERICAN PROMOTIONAL EVENTS NW TOTAL FEES: Applicant's Affidavit: I certify that I have read and examined the information contained within the application and know the same to be true nd correct. I also certify that the proposed structure is in conformity with all applicable City of Yelm reg lati s including those governing zoning and land subdivision, and in addition, all covenants, Basemen s restri 'ons of record. If applying as a contractor, I further certify that I am currently Date Firm Fees $ 30.00 $ 30.00 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: ay: APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWH7106 TO: Governing body of city, town, or county in which DATE OF JAN. 20, 2010 fireworks stand will be located . APPLICATION: Applicant Name: Address, City. State: RELAY FOR LIFE- YELM 2120 MILWAUKEE WAY, TACOMA„ WA 98421 TRANSPORTATION Sponsor (If other than applicant): Address, City, State: JENNIFER ANDREWS 2120 MILWAUKEE WAY, TACOMA„ WA 98421 Location of proposed fireworks stand: [Enclose drawing of stand location] 905 E YELM AVE YELM, WA RITE AID 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 .Yalu 4tn From: ~ ~-P ~ -J k ~ Z~ . z E ~ O Sales For December 31st From: i z ~~~ ~e c o w~ la ~ ~7, Z ~~ t To: ~l ,,~. J.L. 5~ 7 n( ~ ~ ( Sponsor: RELAY FOR LIFE- YELM TRANSPORTATION Location: RIT ID 905 E YELM AVE YELM WA /s/ /s/'~,~4,.c~~erv~-~.. FOR JENNIFER ANDREWS Signature of Official Granting Permit Signature of Applicant Title: ~l,^ ~~ t^~i ~~~~ cam/ Agency: ~ ~~ v~ ~'~`~- Date: y 9 Permit Number: 2© l~ u b~~ Licensee Name: RELAY FOR LIFE- YELM TRANSPORTATION License Number: 011q, 3(IOU-4?0-OU (Rev. JOS) Ci~~ ~f Y~1;~ 'rGi 453-°4C'^ oPEr: cn ~~,., ~ , - jcn.~i` ,t0, 201G~GG60 j?, ~ PEP,~i ~,., ~~L;IGr~r~ rn"iEr`j~Aia Pz,~~,~rTi?~'~JAi !)F~'T~ ~,;u '~05 Y'FLM A~JE F E,._~'"~ FIkE 3Ci°GrrF, TEr,DERED: 3G,Ot;' CHECK AP'PL'IED: jf rn_ CHr{rtuE: ;, ;, G,, Zof v o0 (o Z~ March 31 , 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 # 30002258, 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 TACOMA (253) 922-0800 • SEATTLE (253) 838-1099 FAX (253) 830-2930 www.tntfireworks.eom ~g~~~~gD APR 0 2 2010 B Y: ------------------- Inw~fC..? 1~--v , O t1~t1__n N i ~rL'-tf ~ ~]W~ ~ `/ ~ i Q o <<,; E Washington State Patrol Fire Protection Bureau Office Of The State Fire Marshal Washington State Fireworks License Licensee Information ~f`~ W ~~~IC~,o 11 189 Fireworks Stand License License is Non-Transferable and Valid for Only One Stand Relay For Life - Yelm Transportation 2120 Milwaukee Way Tacoma, WA 98421 License Number: WSPFL-01791 Stand Information Contact Person: Jennifer Andrews Phone Number: (360) 400-1080 County: Thurston Date of Expiration Date of Issue Stand Number: SN-04914 January 31, 2011 March 18, 2010 Stand Location: (Stand Location To Be Completed By Licensee) 3000-420-012 (R 9/05) -'-~ r% ~~~'~L State Fire Marshal Signature Detach this wallet card and carry with you for verification of certification. o (1 Washington Slate Patrol 1 1 18 9 ' Fire Protection Bureau Office Of The State Fire Marshal ~ Licensee: Relay,ForLife- Yelm Transportation Contact Person: Jendifei:Andrew"s. !License Number: WSPFI-01791'.,''- ' Stand Number: SN 049114 " [Valid For One Stand) ;Dale of Expiration: January'.,31j~20f1--,° Location: -:~+~'". r.r ~ .. ;,--. (Stand Location ~To Be Completed By Licensee) S[a[e Fire Marshal Signature Licensee Signature ACORD,. CERTIFICATE OF INSURANCE ISSUE DATE 02/25/2010 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 nol amend, extend or alter the , , Box 10265 ~ P O coverage afforded by the policies below. . . Birmingham, AL 35202 800-476-2211 COMPANIES AFFORDING COVERAGE Com pany Columbia Casualty Company p 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 con tract or other document with respect to which this certifcate 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 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 ®commercial General LiabiRV 11 /0112 01 0 FIRE DAMAGE $ 200,000 ^Claims Made ®o~nerranea ^ Owners' antl Conlracrors' Protection MEDICAL EXPENSE $ EXCLUDED ^ PERS. AND ADVERTISING INJURY $ 1,000,000 ^ ~ GENERAL AGGREGATE $ 2,000,000 General Aggregate rmn pnes per: ap PRODUCTS AND COMP.OPER. AGG. $ 2,000,000 p ~ ^ Policy ^ Proled ®LOCation AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ^Any Automobile BODILY INJURY Per erson $ ^ All Ownatl PLtomabiles ^ scheduled AmomobJes BODILY INJURY Per accident $ ^ Mo-ea AUmmohlles PROPERTY DAMAGE Per accident ~ $ ^ Nan-awned Automobiles COMPREHENSIVE ^ COLLISION WORKERS' COMPENSATION WC Statutor Limil Other AND EMPLOYERS' LIABILITY EL EACH ACCIDENT $ EL DISEASE Each em to ee $ EL DISEASE Polic Limit $ EXCESS LIABILITY EACH OCCURRENCE $ ^occarrence ^Claims made AGGREGATE $ Re: Rite Aid Located at 905 E Yelm Ave. in Yelm, WA (Loc# W WH7106). The Certificate Holders are Additional Insureds under 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. Relay for Life-Yelm Transportation Rite Aid Authorized Representative City ofYelm PO B 479 ox YeIm,WA98597 w~-6'~~••~ -~~gII~~ Page 1 of 1 f I C M v n ~ •+ ..vw C) I: ~~ FIREWORKS LEASE AGREEMENT This agreement is made between THRIFTY PAYLESS INC. as Lessor and AMERICAN PROMOTIONAL EVENTS NORTHWEST as Lessee. 1. AMERICAN PROMOTIONAL EVENTS - NW, will lease a portion of the property located at See Addendum "A" for the sale of approved fireworks from the following premises (hereafter called the "Location"): 2. The leas _per year for the period of June 20`h thru July 9"' (2009)(hereafter called the "Season"). Payment shall be paid upon execution and May 15"' of each year. 3. Lessor represents that the Location is owned and/or controlled by the Lessor and furthermore that the Lessor agrees to grant the Lessee the exclusive right to operate a fireworks sales structure (hereafter the "Structure") through the year 2010 for the above-mentioned period. 4. The Lessor hereby grants Lessee a first right of refusal to match any bona fide offer to lease the Location for fireworks sales during the renewal Seasons. 5. In return, Lessee agrees to the following terms and conditions: a. Provide an A+ rated $20,000,000.00 certificate of insurance, prior to occupancy, evidencing liability insurance in force covering the erection and operation of the Structure. Insurance shall name Lessor as additional insured, and Lessor shall be held harmless from any claims arising from the maintenance or operation of the Structure. b. Pay any and all costs involved in erection, maintenance, and operation of the Structure, and Lessee shall guarantee that the Location will be returned to its original condition. c. Obtain and pay all necessary permits and licenses required by law, post with local authority any debris or performance bonds as required, and guarantee that all laws and regulations shall be adhered to. This agreement is contingent upon Lessee securing necessary permits and licenses. Lessee may cancel this agreement if the sale of fireworks is prohibited at this Location by a public authority or such sale, in the good faith opinion of Lessee, becomes commercially unreasonable. In such an event any deposit shall be refunded to Lessee. Agreed t ate his d of Accepted' Lessor: Rob Lambrecht Thrifty Payless Inc 14625 SW Allen Blvd., Suite 101 Beaverton, OR 97007 ~ Phone:503-520-7206 ' ~ TAX ID #: 2008 Accepted: Lessee: Ke neth A. Spence AMERICAN PROMOTIONAL EVENTS - NW AMERICAN PROMOTIONAL EVENTS, INC. 2120 MILWAUKEE WAY • TACOMA, WA 98421 TACOMA (253) 922-0800 • SEATTLE (253) 838-1099 FAX (253) 830-2930 www.tntfireworks.eom ~~~~~~~D `~ APR 0 2 2090 's ~~: --_'---' Location # Location Name Address Line 1 Cit ST Year Lease Sts WCS4197 RITE AID #5319 1329 LEE BLVD RICHLAND WA 2010 Secured WWH2462 RITE AID #6503 3733 116TH ST NE MARYSVILLE WA 2010 Secured WWH3154 RITE AID #5184 22631 BOTHELL-EVERETT HWY SE BOTHELL WA 2010 Secured WWH3160 RITE AID #5180 19107 BOTHELL WAY NE BOTHELL WA 2010 Secured W WH4678 RITE AID #5263 128TH & MERIDIAN PUYALLUP WA 2010 Secured W WH5550 RITE AID #6462 2700 MILLER BAY RD NE KINGSTON WA 2010 Secured WWH6552 RITE AID #6544 23940 NE SR 3 BELFAIR WA 2010 Secured W WH7106 RITE AID 905 E YELM AVE YELM WA 2010 Secured . WWM5527 RITE AID #5260 3304 BETHEL RD SE PORT ORCHARD WA 2010 Secured WWM5714 RITE AID #5253 4220 WHEATON WAV BREMERTON WA 2010 Secured W WS4199 RITE AID #5172 1509 AUBURN WAYS AUBURN WA 2010 Secured WWT3064 RITE AID #5193 9820 NE 132ND ST KIRKLAND WA 2010 Secured WWT4653 RITE AID #5274 15801 PACIFIC AVE SPANAWAY WA 2010 Secured R,,~ 1.-J o o N a ~ o ~"~ a f7 (° >- m ~\ ~~~~ ww~~ia~ X05 ti.. ye\m e ~~`l~ y e\m , Wfl 1 . ~-y ~= _ _ ,.,... S~ ax~c~ __.~-`. ~:. G~B~?l~ Q APR 0 2 201fl ~3 ~~: --------------------