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20140187 Permit Pkg 06132014 �Q� tH�p� City of Yelm Permit ►vo.: 20140187 � , � �9� Community Development Department Issue Date: 6/13/2014 d = � (Work must be completed within 180 days) Building Division Phone: (360)458-8407 YELM Fax: (360)458-3144 Applicant: Name: AMERICAN PROMOTIONAL EVENTS NW Phone: 253-922-0800 Address: 2120 MILWAUKEE WAY TACOMA WA 98421 Property Information: site Address: 905 YELM AVE E Owner: RITE AID Assessor Parcel No.: 22730121200 Subdivision: Lot: Contractor Information: Name: AMERICAN PROMOTIONAL EVENTS NW Phone: Address: KERRI MCTIGUE 2120 MILWAUKEE WAY TACOMA WA 98421 Contractor License No.: Expires: 0/00/0000 Project Information: Project: FIRE WORKS Description of Work: Sq. Ft. per floor: Heat Type(Electric,Gas, Other): First Second Third Garage Basement Fees: Item Contractor Fees FIRE AMERICAN PROMOTIONAL EVENTS NW $ 30.00 TOTAL FEES: $ 30.00 Applicant's Affidavit: OFFICIAL USE ONLY 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 ceRify th t the proposed structure is in conformity with all applicable City of #Sets of Prints: Yelm reg lation clu ing those g ing zo g and I subdivision, and in addition,all covenants, easemen s restri ions of r o . I applyi g as a co tr ctor, I further c ify that I am rrentl Final Inspection: registere in t ta s i g � � Date: Signature t By: Firm Cit� of Yelm (36 ) 458-8402 REC#: 00163355 6/13/2014 I1;45 AM OPER: Cp TERM: 001 REF#: 3003�498 TRAN: 33,pp00 BUZ�plNG PERMITS 20140187 30.00CR AMERICAN PROMOTSONAI. EVENT� N{� 905 YELM AUE E FIRE 30.00CR TENDFRED; 30.00 CHECK APPLIED; 30.00- CHANGE; �`0 2�� June 5, 2014 Community Development City of Yelm 105 Yelm Avenue West Yelm, WA 98597 Dear Community Development Dept, Enclosed is a check for $30.00 and all applicable information to apply for 1 temporary retail fireworks tent permit for the upcoming 2014 July season. If you have any questions, please feel free to contact YESENIA LAMM at (253) 922-0800. Thank you for your time and attention to this matter, and allowing us to operate our fundraiser in your wonderful city. Sincerely, Kerri McTigue Licensing & Permits American Promotional Events, Inc. - Northwest Enclosure(s) AMERICAN PROMOTIONAL EVENTS, INC. ��c�� 2120 MILWAUKEE WAY•TACOMA,WA 98421 TACOMA(253)922-0800 • FAX(253)830-2930 �UN 11 2014 www.tntfireworks.com BY: ��,�F THEp�'� City o f YeZm � �0. YELM SPECIAL EVENT/TEMPORARY USE WqSMINCTON � Special Event Sign Permit � Temporary Use Start Date: 6/28/2014 End Date: 7/5/2014 Applicant: HAPPY BIRTHDAY AMERICA Owner: )OYCE STOCKMYER Address: 1301 E. YELM AVE Address: 1301 E. YELM AVE YELM WA 98597 YELM WA 98597 Telephone: 360-292-9484 Telephone: 360-292-9484 Email: Email: Representative: �OYCE STOCKMYER Mailing Address: 1301 E. YELM AVE YELM WA 98597 Telephone: 360-292-9484 Email: General location of the project: RITE AID 905 E YELM AVE Assessor's Tax Parcel Number: Description of Project: TEMPORARY RETAIL FIREWORKS STAND RAN FOR FUNDRAISING PURPOSES Attach a site plan no larger than 11" X 17" showing the proposed development. Yelm City Hall (360)458-3244 105 Yelm Avenue West (360)458-4348 FAX Yelm,WA 98597 www.ci.yelm.wa.us . _ __ ACO� DATE(MAAIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE ,,,,,2o�a 6/5/2014 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain poiicies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemerrt(s). CONTACT PRODUCER Lockton Companies NAME: 3280 Peachtree Road NE,Suite#250 PHONE F^X N ac r+o: Atlanta GA 30305 E-""a� ADDRESS: (404)460-3600 INSURER S AFFORDING COVERAGE NAIC# iNSUReR n:Everest Indemni Insurance Com an 10851 INSURED INSURER B: 1359629 American Promotional Events,Inc. DBA TNT Fireworks,IriC. INSURER C: P.O.Box 1318 INSURER D: 4511 Helton Drive INSURER E: Florence AL 35630 INSURER F: COVERA CERT{FtCATE NUMBER: 12402944 REVISION NUMBER: XXXXXXX 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 CONOITION 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. INSR ADD SUBR POLICY EPF POLICY EXP L,IMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MM/DD A X COMMERCIALGENERAL LIABILITY }� N SI8GL00242-131 l I/1/ZO13 1 UI/ZO14 H RR DAMAGE TO RENTED $ 3OO OOO CLAIMS-MADE �OCCUR PREMISES(Ea occurrence) MED EXP An one erson , PERSONAL&ADV INJURY $ 1�OOO,OOO GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 O O O POLICY � �E� ❑X LOC PRODUCTS-COMP/OP AGG $ Z O $ OTHER: AUTOMOBILE LIABILITY NOT APPLICABLE (Ea accident) $ X ANY AUTO BODILY INJURY(Per person) $ � ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS NON OWNED PROPERN DAMAGE $ XXXXXXX HIRED AUTOS AUTOS $ XXXXxXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE S CXX� �X DED RETENTION$ $ � WORKERS COMPENSATION NOT APPLICABLE STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE N�A E.L.EACH ACCIDENT $ OFFlCER/MEMBEREXCLUDED? (Mandatory io NH) E.L.DISEASE-EA EMPLOYEE $ }��{}��(}�}( If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ X DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be altached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREViOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPI.ICABLE TO THE CARRIERS LISTED AND THE POLICY 7ERM(S)REFERENCED. Located at Rite Aid 905 E Yelm Ave,Yelm,WA(W WH 7106)Certificate holder is an additiona]insured on the General Liability as required by written contract subject to policy terms,conditions,and exclusions. CERTIFICATE HOLDER CANCELLATION 12402944 CI of Yelm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE tY THE EXPIRATION DATE THEREOF, NOTICE WII.L BE DELIVERED IN Happy Birthday America Joyce Stockmyer ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 479 Yelm WA 98597 AUTHORIZED REPRESENT T VE - �� ".�j�,�� ' -"" �� OO 1988-20�ACORD CORPO TION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD o i o � ao � � ; oo W � ,� � � _ �� cn z � � _ �I o r � � !— /�1 s I � V p ;� on ^, � � ro �, � � \Y/ r 3 o I 'c '"a `° � �o ° V i � U � � �� A�._ � � � .� � � •�I � � a, � v ¢� �' � :� � ' p � � � � � � �, �i �' a .:�� c� � �b o II `� o °.,' � ��'�;;��:�� q� � I � � � x d`� �o-�h�"�� d o � a� '� ° �' va�T �.�o � � � �'�- � � �° �°. .c ��.�w.n, �., � 4 �� aH3 ��.o � , � _ ; � � �.N ; i � � ow�xa��•��-� � '� r �� 3 u � � - �� " C � V1 " � � Q � .. i: ° "� s -o p� a� � . :r Ci �(� i � o � y y,�, `� � °' �Y I Z L E � �a � � � � I Z ;; �" � ' W c ii �` � , � i � N � � z �.. o � c , . � � � I 6Ci C d C � � � :tl ^ I u u � � u �n O z i 'a �a � Aa � � � � . � ----------- ---- -- U � N ��y � r'-1 ~ �--1 •� �- N � � O �O G� � A � w v� p~ � � � � a� 3 � � � o � � ° •i'"� y ��'�'' p �, � M�1 ^� .� N 'rt 3 � " �: � �, � z w "' � � �,+ �, �, � ° � O � U O a c�C O y � � � � � � � � � ti � �• A a � � � ''� o � ❑ � •� � o +� o ::� c�g � � � � � �, Q � C I." '� � � O � Q, E� `+-� � � � e � O � �N � � � o � 3w � a �, � � � U .� �,,� � O G � `n � Z � � o � �N c�l �E-� v� .. � � o�o o � � � ° � � �, � � � � .Q ��.' .a p x `� S" � p� N � � � 3 � o azUZ � � 0 !� � � � cd � � ��., � r.� Q � 25 �S � �, � � O C� 'C r, I� y �O O p O .0 +-' t � �i N E-� C%� � � � C!� FIRE PROTECTION BUREAU '''"�'a�'�' FIItEWORKS LICEN5ING PROGRAM PO Boa 42600 � Olympia WA 98504-2600 �'.�.,�,.,+�'� (360)596-3914 FAX: (360)596-3934 �' APPLICATION FOR RETAIL FIREWORKS STAND PERNIIT TO Governing body of city,town,or county in which DATE OF 4/10/2 014 fireworks stand will be located. APPLICATION Applicant Name JOYCE STOCKMYER Address,City,State HAPPY BIRTHDAY AMERICA 2120 MILWAUKEE WAY, TACOMA WA 98421 Sponsor(If other than applicant) Address,City,State JOYCE STOCKMYER 2120 MILWAUKEE WAY, TACOMA WA 98421 Location o#proposed fireworks stand [Enclose drawing of stand location] RITE AID 905 E YELM AVE YELM WA M$nner and place of storage prior,dnring,and a�er sales dates In Stand With Security State-Licensed Fireworks Supplier AMERICAN PROMOTIONAL EVENTS 2120 MILWAUKEE WAY, TACOMA, WA 98421 - - ------- --- ---- -- -- - --- - -- - ------ - -- - ------ -- - --- - -- - ---- -- -- - - - -- FI�.EWOR`KS STAND PERIVIIT 2014 For the Fireworks Sa1es�ear of: {Must be conspicuously displayed at a1I 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 as the local governin.g 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 ti.mes: Sales for July 4`� Sales for December 31't From: ��b M ��Z1� / %�f From: To: �j ,o� 7 �//�/ To: S�OIlSOL HAPPY BIRTHDAY AMERICA JOYCE STOCKMYER Location RI E YELM AVE YELM WA �S� �� i/� � '�,G" FOR JOYCE STOCKMYER Signature ci�r�an�Permit ignature of;` pplicant Title �, G��,.�C Agency �j�i� O� ��F�---=�__ Date Permit Number HAPPY BIRTHDAY AMERICA 02720 Licensee Name ��vc�F STOCKMYER License Number 3000-020-013(R 3/09) �u� � -ia� �- ��5 � `��e�n ��- � ��.�� ,� �,��;,.�- -- - � -�__.� -- -- _ - � . � _ - - � � , � .,\ , . � � t . , . . - ,. . . _ �- j � _ ..q.. s�,, - '� ��C+.�CI�� i , 1. _ - - �-- ---- .��- - ..--- / l _ - �--�. _,��_ ;'.., i �J � , H- -' ' f' _ _ � � � . - � .--° _ � - � � l� i � _.. I , { I � a � � F�REWORK3 L SE AGREEMENT 1 Th�� s 7'hdysr pa�t��Inc. Lesscr snd AMERICAN PROMO'�t0 L EVENTS NOR ST�e Le.gsee. i. AM ICAN PROMOTI L EVENT3-N1A►,+�i8 le�e a Partion°f the Pi°pertY Ioca�ad at !a�Add�n_d-� °g"for ti�e sate of lirewattcs from the follawing premises(hereeRer ceuee the°lc o�►': 2. The t�ee paynteRt wtU ��'"thiru Ju�7n' eresRer called tfte . .. P�� 3. r�reser►ts thet Loc�wr�� ...WOr conaareai rby t�e Lessor and furtl�ertnc�re thst 1he Leseor t�gra�t a� the exdus�re rigfit to operebe a flreMrcitcs aates stru�tu�(hero�Poer the'3truc�re� th h the y�ear�,or 8bove�nentloned perlod• 4. The Lessor hereby graMs a ftrst�EgM of rett�sal to ma�ch any bona flda otfer to leas�the Lot�tlan fo� rks sales during the ewsF S�sons. 5. In m.Lesaee agreea tlte folb�wing t�rma and oondftlons: a. e an A+�ated 3 O�OOQ.000.00 oertlflc��e of ir�suranoe,prtor to aocupency.ev�dandng Ilabltity noe in 1�onoe ng the er+ection artd operatlan o!Ihe Sfiudure.Insu►aROe ahaii�ame t.es�ar as �ttalef Msursd. I.�ssor sha11 be hetd hartMesa trom any datms aclstng trom the e�eln�nanoe or pe�a�on of the . b. ay arty and aR c�s in e�ectio�,main�nanoe,and opeta�on of the Strucbur�e.+�rtd lessee shali �an�ee that the L on wiU be�efumed to ite orlglrtei ooRditlon. c. bt�dn and pa�r a11 n pa�mits snd Boenses�equired by law�post with local authority any debrls cr rbrmenoe boRds as requfred,asd guaran6ea tl�st all lews artd regulalio�shBQ be adheied b. 6. This gc�emerrt Is oo�trt upon Legsee�►inD Reoe�aiY Pe�and Qoenses.Lessee mey canoel ih� ag e�t if ths sate ot is pr�Dibed at th�Loc�tlon by a pubtt�authortty or such te�in the good falth pinion af Lessee. oomnte�+dedy unressor�aWe.M sudt an event any depo�t�f be nefiu�ded to �►greea and c�cea et�rs day ot . �z Acoe Aooepted: Lessor. Lau�br�echt Lessee:K A.Spen� I rfRy Psylsss/na. AAIER/CAM FROMOT10NAt EVFNTS I-NW � 38 SWAp�r► SnMe!01 �� na:5Q3-7�d ! AMERICAN PROMOTI�NAL EVENTS,INC. z1�0 MILWAUKEE WA�!•TACOMA,WA88421 AtAMA(253)922-0800•SEI►TTLE(253)838-1098 ! FAX(253)830-2930 � www.tntf�rewortcs.com � i � � 0 i RiTE AID ADDENDUM"A" RtfE AID#I CRY,STA DP LOCATiON# LEASE AMGt1NT 541d MCCAL�,ID 3638 L586699 Sl 00.00 �«URt.I' 5409 U1l,D1NELl„ p 83605 kSB7381 ✓ Si .00 5417 BOISE.tD 706 ISB74$4 � S2�OOO.001 5413 BOiSE,ID 8 02 ISB7575� $2,SOO.QO 5347 PORitMtD, R 97214 OWH1191� S2 00�•� 5391 8EN0 OR 02 OWf6S59 S3,SOO.dO 5388 KtAMATH F OR 97601 ONRY852 S2 000.0� � 5172 AUBURN. WWB4139 51.500•00 sisa eon�EU„ 9so�t� wMrFraisa sa.aoo.00 ! 5263 PUYALLUP, A 98375 {AIVVH4678 51,500.00 SZ86 YEIM,WA 97 1NWH7►106 $1 .00 S2bt1 PORT OR O,WA 98366 W WM5527 SZ.200.00 5253 BREME ,WA WWM5714 $1,600.00 5274 SPANAWAY WA WWT4653 $3.OQD.00 TOTAI: S�.700•00 � � I I � t