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25 Yelm State RetailTHIS FORM IS INTENDED FOR USE BY LOCAL AUTHORITIES HAVING JURISDICTION (AHJ) IN THE EVENT THEY DO NOT HAVE A PERMIT FORM SPECIFIC FOR RETAIL FIREWORKS SALES AT A CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY. IT IS NOT MEANT TO BE REQUIRED IN ADDITION TO OR IN LIEU OF ANY LOCAL PERMITTING FORM AND/OR PROCESS THAT MAY EXIST WITH THE LOCAL AHJ. Directions: Provided the local jurisdiction has no permit form of their own, complete this permit application and submit it with the local AHJ portion of your Retail Fireworks Stand License to the jurisdiction in which you wish to run your CFRS facility. WASHINGTON STATE FIREWORKS RETAIL SALES PERMIT APPLICATION Aeelicant Information D New/First Time Applicant D Previous Permit Holder Name of Group, Organization, or Person (Last, First, Middle Initial) Issued the Fireworks Retailer License FUNDS FOR KIDS Name of Permit Applicant (Last, First, Middle Initial) PO Box 5394; Spanawa~, WA 98387 Permit Applicant Mailing Address (Complete Including Street, City, State, and ZIP Code) ( 253 ) 279.1247 wcfireworks@icloud.com ( ) Phone Number E-Mail Address Local Business Number (if required) CFRS Facilit~ Information Stand Drent Other: Size: 8'x20' Specify Square Feet/Dimensions 906 Algiers Drive NE; Yelm, WA 98597 CFRS Facility Address (Complete Including Street, City, State, and ZIP Code) Yelm Plaza LLC ( ) 22730110204 Name of Property Owner or Authorized Representative Phone Number Parcel Number for Stand Location Fireworks Supelier Information List all of the licensed fireworks wholesalers who will be supplying this stand product Winco Fireworks Storage Information D On Site 0 Off Site: Storage Address (Complete Including Street, City, State, and ZIP Code) Iv" I Sales Structure D Detached Building D Truck/Trailer D Other: Specify CHECKLIST FOR SUBMISSION Check with the local AHJ for all applicable submission dates and deadlines: D Application/Permit Fee D Insurance Certificate ($1,000,000) D Clean-Up Bond Fee (if applicable) D Valid Washington State Fireworks Retailer License D Property Owners Written Permission D Detailed Site Plan D 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 state of Washington and the city/county permitting this CFRS Facility. faJ()fl ~ad Charity Utterback 04/24/2023 Signature of Permit Applicant Printed Name of Permit Applicant Date of Signature THE FIREWORKS RETAILER LICENSE HOLDER (LICENSEE) SHALL RETAIN THIS PERMIT WITH THE ASSOCIATED FIREWORKS RETAILER LICENSE AND MAKE THEM BOTH AVAILABLE FOR INSPECTION AT ANY TIME THE STAND IS IN OPERATION 3000-420-013 (R 1/18) CITY OF YELM COMMERCIAL BUILDING PERMIT APPLICATION FORM ProjectAddress:906 Yelm Ave EaSt Parcel #: 22730110204 Zoning; Comercail Current Use: Grocery Store/ f Proposed Use: Consumer Fire D New Construction o Re-Model I Re-Roof I Tenant Improvement o Plumbing o Mechanical o Fire Prevent/Suppress/Alarm 0 Other Project Description/Scope of work: Retail sales of 1.4 G Consumer Fireworks Class C Project Value:_N_A _________________________ _ Building Area (sq. ft) Parking Garage N/A 1st Floor 1600' 2nd Floor N/ A 3rd Floor N/ A Building Height N/ A Are there any environmentally sensitive areas located on the parcel? _n_o __ _ If yes, a completed environmental checklist must accompany permit application. BUILDING,.O_wN B/IE~M8:_e_m ______ re_a __ a _________ _ ADDRESS 18230 East\/allev Hwy. EMAIL _NA~------- CITY Kent STATE WA ZIP 98032 TELEPHONE 1-425-982-0049 _,, f_N_A _________ LICENSE# ________ _ ADDRESS EMAIL _________ _ CITY STATE ZIP TELEPHONE ·tt~~,';~~•::~;-;:-;,'1~:~, ~,t=~~ ,.~f:' ,,__ -• • "--~.-. • '-\ • .. •" • C _N_A ________ TELEPHONE _______ _ ADDRESS EMAIL ---------------------------CI TY ______ S TATE ___ ZIP FAX"------------ CONTRACTOR'S LICENSE # EXP DATE_CITY LICENSE# ~N~A _________ TELEPHONE _______ _ ADDRESS _____________ EMAIL _________ _ CITY ______ STATE ___ Z.IP FAX. __________ _ CONTRACTOR'S LICENSE # EXP DATE_CITY LICENSE# --NA TELEPHONE ADDRESS _____________ EMAIL _________ _ CITY ______ STATE ___ ZIP FAX. __________ _ CONTRACTOR'S LICENSE # EXP DATE_CITY LICENSE# ___ Copy of City Mitigation documentation (TFC). I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above described property will be in accordance with the laws, rules and regulations of the State of Washington and the City of Yelm. 04 I 24 I 2023 Applicant's Signature Date Owner/ Contractor I Owner's Agent/ Contractor's Agent/ Tenant (Please circle one.) All permits are non-transferable 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 105 Yelm Avenue West POBox479 Yelm, WA 98597 (360) 458-3835 (360) 458-3144 FAX www.ci.yelm.wa.us . '· . - - : . .., . . . . . : , - -.. A Su n Bi r d s ~ . : : : a 40 ' x 4 0 ' T e n t ~ ( f a l~ _ { · , r - 4 ~ ~ , . : - , ~i ! J ! \ ... . . . _,' • / ·t ~ . ; .. !l i i i • \! ! J <. ~- .- ·· ~ · - 4i l • Y: . ' - ' ~ - , --. ~ , , ; . , . . ' . , ~ , / J~ ; 4 - . , , ~ ... . ~: .. ,i - - - . ~ - . • ~ . . . . . . : . 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