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20160245 Permit Pkg 06072016City of Yelm Community Development Department Building Division Phone: (360) 458 -8407 Fax: (360) 458 -3144 Applicant: Name: JESUS NAME PENTECOSTAL Address: 2120 MULWAUKEE WAY TACOMA WA 98421 Property Information: Site Address: 11 n vm M AVF F Assessor Parcel No.: 85810000100 Subdivision: N/A Contractor Information: Name: AMERICAN PROMOTIONAL EVENTS NW Address: 2120 MULWAUKEE WAY TACOMA WA 98421 Contractor License No.: Permit No.: 20160245 Issue Date: 6/07/2016 (Work must be completed within 180 days) Phone: 253 - 922 -0800 Owner: SAFEWAY STORE #1619 Phone: Expires: 0 /00 /0000 Lot: N/A Project Information: Project: FIRE WORKS Description of Work: FIREWORKS STAND - SAFEWAY PARKING LOT. SEE CONDITIONS ON MAINTAINING CLEARANCE ON SITE MAP Sq. Ft. per floor: First Second Third Garage Basement Fees: Item FIRE Heat Type (Electric, Gas, Other): Contractor AMERICAN PROMOTIONAL EVENTS NW TOTAL FEES: Applicah Is 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 applicable City of Yelm regulati including those governing zoning and land subdivision, and in addition, all covenants, easements an &Statef i s of record. If applying as a contractor, I further certify that I am currently registered in t Washington. Signature T Date / w'1' Vto Firm ICN—_ . w ��► �� �— 1� 2A�1 a_ li iD a� ut Fees $ 30.00 $ 30.00 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: City of Mi (36 ) 458 -3244 REC #: 00233473 OPER: CO TERM REF #: 30043878 PAID BY: 6/07/2016 3:41 PM 001 TRAN: 33.0000 BUILDING PERMITS 20160245 30.000R JESUS NAME PENTECOSTAL 1109 YELM AVE E FIRE 30.0(;CR TENDERED: 30.00 CHECK APPLIED: 30.00- CHANGE: 0 2120 Milwaukee Way Tacoma. WA 98421 Number: (253) 922 -0800 County of Operation: Operates For: Stand Operated By: Date of Issue -April 21, 2016 Date of Expiration: January �5-i , zu-i r Consumer Fireworks Retail Sales Stand Licenses issued after May are ONLY valid for New Years This license is NOT valid without a permit from a local fire code official/authority having jurisdiction. This license allows for operation of a single location /stand retail sales to the public of state legal consumer fireworks purchased only from a licensed fireworks wholesaler. THIS LICENSE PORTION ACC F (J �► p�RAdlTAPPLICP+TIQN FIRE PROTECTION BUREAU FIREWORKS LICENSING PROGRAM PO Box 42600 Olympia WA 98504 -2600 (360) 596 -3914 FAX: (360) 596 -3934 APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWT7105 TO Governing body of city, town, or county in which DATE OF fireworks stand will be located. APPLICATION APRIL 20, 2016 Applicant Name Address, City, State JESUS NAME PENTECOSTAL 2120 MULWAUKEE WAY - TACOMA WA 98421 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 locatioul SAFEWAY STORE #1619 - 1109 EAST YELM AVE - YELM WA 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: 2016 (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 as 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 31st From: JUNE 28, 2016 From: To: JULY 4, 2016 To: Sponsor GREG MATTOCKS Location SAFE STORE #1619 - 1109 E. YELM AVE - 98597 -- - 7 FOR GREG MATTOCKS /s/ Signature of Official Granting Permit Signature of\ApplIA t Title 01( 'Gt&1( / ,5�4ency Date (e . `'� . (e ermit Number afl(& Licensee Name JESUS NAME PENTECOSTAL License Number ILI - 1 A 5 3000 - 420 -013 (R 3/09) Google Maps UK3 Ui 7105:7 Page 1 of 2 https : / /www.google.com /maps / @46. 9346287 ,- 122.5938734,118m/data =!3ml ! 1 e3 4/18/2016 A CORO® C4 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/1/2016 4/20/2016 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 policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Companies CONTACT NAME: PHONE FAX N A/C No 3280 Peachtree Road NE, Suite #250 Atlanta GA 30305 E -MAIL (404) 460 -3600 ADDRESS: 11/1/2016 EACH OCCURRENCE $ 1000 000 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Everest Indemnity Insurance Company 10851 MED EXP (Any one person) INSURED American Promotional Events, Inc. 1359629 INSURER B: DBA TNT Fireworks, Inc. INSURER C: INSURER D: P.O. Box 1318 4511 Helton Drive Florence AL 35630 INSURER E: GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE INSURER F COVERAM t /LUD CERTIFICATE NUMBER: 12340084 REVISION NUMBER: XXXXXYX 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 CONDITION 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDMIYY POLICY EXP MM /DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR Y N SI8GL00242 -151 11/1/2015 11/1/2016 EACH OCCURRENCE $ 1000 000 PREM sT Ee occurrence $ 500,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY RQ FX LOC POTHER: PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT Ee accdent $ XXXXXXX BODILY INJURY (Per person) $ )(YY � ANY AUTO BODILY INJURY (Per accident) $ XXXXXXX ALL AUTOS OWNED SCHEDULED AUTOS PROPERTY DAMAGE Per accident $ XXXXXXX NON -OWNED HIRED AUTOS AUTOS _ $XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX_ HCLAIMS-MADE AGGREGATE $ XXXXXXX EXCESS LIAB DED RETENTION $ $ XXXXXXX WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y /❑N NOT APPLICABLE PER OTH- STATUTE ER $ XXXXXXX_ E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA E.L. DISEASE - EA EMPLOYEE $ XXXXXXX describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $ XXXXXXX DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED. Located at Safeway 1109 Yelm Ave E, Yelm, WA (W WT7105) Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms, conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION 12340084 City ofYelm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Yelm Jesus Name Pentecostal Church THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 479 ACCORDANCE WITH THE POLICY PROVISIONS. Yelm WA 98597 AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) ©1986-- 201AAC6RD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD REVOCABLE LICENSE AGREEMENT THIS REVOCABLE LICENSE AGREEMENT ( "Agreement") is made as of the /� of 2016, by and between Safeway, Inc., ( "Licensor "), and AMERICAN PROMOTIONAL EVENTS, INC. - WEST, dba TNT FIREWORKS ( "Licensee "). WHEREAS, Licensor owns or leases a retail supermarket in the United States ( "Store Premises "); and WHEREAS, Licensee desires to enter upon a portion of the parking lot of the Store Premises (such portion being referred to herein as the ( "Licensed Premises ") for the sole purpose of Firework sales; NOW, THEREFORE, in consideration of the foregoing recitals, the mutual promises and covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Licensor and Licensee agree as follows: 1. Licensor hereby grants to Licensee, and Licensee hereby accepts from Licensor, a license to use the Licensed Premises on the attached Exhibit "A" for a term commencing on June 14, 2016, and terminating at 11:59 p.m., local time, on July 10, 2016. Said license shall include non - exclusive use of the common area immediately adjacent to the Licensed Premises for ingress, egress and parking ( "Common Area "). 2. Licensee may use the Licensed Premises only for selling fireworks, sparklers, and novelty sales. Licensee shall obtain, at its sole cost and expense, all licenses, permits and approvals required by any governmental entity for Licensee's use of the Licensed Premises. 3. Licensee shall pay to Licensor, as consideration for this Agreement, the sum as provided in the Master Fireworks Agreement to which this Agreement is attached as Exhibit A. 4. LICENSEE ACCEPTS THE LICENSED PREMISES IN THEIR EXISTING CONDITION "AS IS ", "WHERE IS" AND "WITH ALL FAULTS." Licensee agrees and acknowledges the Licensor is not making, has not made, and expressly disclaims any warranties or representations, express or implied, with respect to any aspect, feature or condition of the Licensed Premises including, but not limited to, the suitability of the Licensed Premises for Licensee's intended use. Licensee acknowledges that Licensee is relying solely upon Licensee's inspection of the Licensed Premises and expressly assumes all risks related to the condition of the Licensed Premises. 5. Licensee shall at all times during the term of this Agreement keep the Licensed Premises and the Common Area in a clean, neat and safe condition. Licensee agrees that it will not alter the Licensed Premises or Common Area in any way, including, but not limited to, driving stakes into the pavement. At all times while upon the Licensed Premises, all agents, contractors and employees of Licensee will observe all rules and regulations which Licensor may prescribe for the protection of the public, its personnel and property, including, but not limited to, safety rules and provisions against smoking. Notwithstanding anything to the contrary in this Agreement, Licensee, and not Licensor, shall be obligated to provide all security services necessary or appropriate for the safe and secure use of the Licensed Premises and the ways immediately adjoining the Licensed Premises by Licensee and Licensee's agents, contractors, employees and invitees (collectively, "Agents "). Licensor shall have no responsibility or obligation in connection with such security and Licensee hereby releases Licensor and the officers, shareholders, trustees, members, partners, limited partners, agents or employees of Licensor or any affiliate of Licensor (collectively, "Related Parties ") from any and all loss, damage, liability and claims (including, without limitation, costs and expenses of litigation and reasonable K:\3rdParty\BNK_DATA\Fireworks \TNT Master \Final Documents\Firework License Agreement (Safeway) 3 916 v2 GD.doc attorneys' fees) (collectively, "Claims ") which arise out of, or are alleged to have arisen out of, Licensor's failure to provide such security. 6. Indemnification. Licensee shall indemnify and defend Licensor, and all Licensor's past, present, or future parent entities, subsidiary entities, affiliate entities, directors, officers, employees, agents, representatives, successors, and assigns, (collectively called "Affiliated Parties ") against any claims, suits, actions, proceedings, judgments, liabilities, obligations, liens, losses, damages, penalties, fines, costs, and expenses, including attorney's fees, court costs, and costs of settlement, arising out of, or having to do with, any actions of Licensee or its employees, agents, Individual Vendors, representatives, contractors, suppliers, guests, visitors, invitees, and licensees, or Licensee's breach of any of its obligations under this Agreement. The indemnity obligations set forth in this Section 6 shall survive the expiration or termination of this Agreement. 7. Insurance. Licensee shall maintain, at its sole cost and expense, at least the following insurance covering its obligations under this Agreement and naming Licensor as additional insureds (except Workers Compensation and Employers Liability) and provide a waiver of subrogation: 7.1.1 Commercial General Liability insurance with broad form coverage endorsement (including broad form property damage endorsement) for personal injury, bodily injury or death, and property damage or destruction in an amount not less than Twenty Million Dollars ($ 20,000,000) for each occurrence; 7.1.2 Comprehensive I Automobile Liability for owned and for hired non- owned vehicles in an amount not less than Two Million Dollars ($2,000,000) for each accident; 7.1.3 Workers' Compensation at statutory limits and Employer's Liability at limits not less than One Million Dollars ($1,000,000). 7.1.4 All insurance required by this Section 7 shall be provided by insurance companies licensed and authorized to conduct their insurance business in the state in which each Licensed Premises is located and rated not less than A- VII by A.M. Best, unless otherwise authorized by Albertson in writing prior to the execution of this contract. In addition, all required insurance shall be evidenced, upon request, on a Certificate of Insurance acceptable to Albertsons; and 7.1.5 All insurance required by Sections 7.1 and 7.1.2 shall include coverage for Licensee and its employees, agents, Individual Vendors, representatives, contractors, suppliers, guests, visitors, invitees, and licensees. 8. Notwithstanding anything to the contrary in this Agreement, this Agreement is subject to all of the terms and provisions of any lease (whether recorded or unrecorded) and any matter of record which affects the Licensed Premises (collectively, "Governing Documents "). Licensee acknowledges that the Governing Documents may contain certain easements, covenants, conditions and restrictions on the use and/or occupancy of the Licensed Premises and /or the Common Area, and Licensee agrees to be bound by and subject to, and to cause its Agents to be bound by and subject to, all of the easements, covenants, conditions and restrictions set forth in the Governing Documents. Licensee agrees that it will not do any act or be guilty of any omission which might be or constitute a default by Licensor under the Governing Documents. if any approvals or consents are required under any Governing Document for Licensee's use of the Licensed Premises or the Common Area, Licensee shall, at its sole cost and expense, obtain the same. K: \3rdParty\BNK_DATA\Fireworks \TNT Master\Final Documents \Firework License Agreement (Safeway) 3 _9_16 v2 GD.doc 9. Licensee shall, at its sole cost and expense, promptly comply with all local, state and federal laws, rules, regulations, licenses, permits and approvals (collectively, "Legal Requirements") and the requirements of any board of fire underwriters or other similar body in relation to or affecting the condition, use or occupancy of the Licensed Premises. Licensee shall not use, or permit the use of, the Licensed Premises or the Common Area in any manner which will in any way conflict with any Legal Requirements. In addition, Licensee shall not use, or permit the use of, the Licensed Premises or the Common Area in any manner which will result in an increase in Licensor's insurance premiums or other costs. 10. Licensee shall keep the Licensed Premises free from any liens arising out of any labor or services performed, materials furnished, or obligations incurred by or for Licensee. 11. This Agreement may be terminated by Licensor (i) for any reason, in its sole and absolute discretion, upon ten (10) days prior written notice, or (ii) immediately in the event Licensor is advised of an alleged breach or default under the Governing Documents or the violation of any Legal Requirements, or upon any breach of this Agreement by Licensee. Except as provided in the Master Agreement, Licensee shall not be entitled to, and hereby waives, any Claims against Licensor for revocation or termination of this Agreement, with or without cause, prior to the automatic termination date. Licensor's termination pursuant to this Section 11 shall not constitute a waiver of any other remedies available to Licensor. 12. Upon termination of this Agreement, Licensee shall immediately, in a good, careful and workmanlike manner, remove its property from the Licensed Premises, repair any damage to the Licensed Premises, and return the Licensed Premises to Licensor in as good a condition as when received. 13. This Agreement is not induced by Licensor, and Licensee states by way of inducement to Licensor that Licensee has determined that there is no violation of any Legal Requirements being committed by Licensee or Licensor in or arising from this Agreement. 14. Licensee may not assign its rights or obligations under this Agreement to any person without the prior express, written consent of Licensor, which consent may withheld in its sole and absolute discretion. 15. All notices given pursuant to this Agreement shall be in writing and shall be given by certified United States mail, or other established express delivery service (such as Federal Express), postage or delivery charge prepaid, addressed to the appropriate party as set forth below: Licensor: Safeway, Inc., Attn: Legal Department -Real Estate 5918 Stoneridge Mall Road Pleasanton, CA 94588 With a copy to: Albertson Companies, LLC. Property Management Department 250 East Parkcenter Boulevard Boise, ID 83706 Licensee: American Promotional Events, Inc. - West Attn: Tad Trout, President 555 N. Gilbert Street Fullerton, CA 92833 K:\3rdParty\BNK_DATA\Fireworks \TNT Master\Final Documents\Firework License Agreement (Safeway) 3 _9_16 v2 GD.doc The person and address to which notices are to be given may be changed at any time by any party upon written notice to the other party. 16. The individuals executing this Agreement warrant and represent that they are duly authorized to execute this Agreement on behalf of Licensor or Licensee, as the case may be, and that no other act, signature or authorization is necessary to bind such person to the terms and provisions of this Agreement. 17. This Agreement and the Master Fireworks Agreement constitutes the entire agreement of the parties with respect to the subject matter hereof and supersedes all prior agreements, oral or written, with respect thereto. There shall be no presumption or standard of construction in favor of or against either party. 18. This Agreement cannot be modified in any respect whatsoever, in whole or in part, except by an instrument in writing executed by both Licensor and Licensee. 19. Licensor shall not in any way or for any purpose be deemed a partner, joint venturer, or member of any joint enterprise with Licensee. 20. The failure of a party to insist upon strict performance of any of the terms or provisions contained in this Agreement shall not be deemed a waiver of any rights or remedies that said party may have, and shall not be deemed a waiver of any subsequent breach or default in the performance of any of the terms or provisions contained herein by the same party. 21. If either party is composed of more than one person, each such person shall be jointly and severally liable hereunder. 22. Each and every term or provision of this Agreement shall be construed to be a separate term or provision and shall be valid and enforceable notwithstanding the fact that any other term or provision shall have been found or declared invalid and unenforceable. 23. Each party hereby waives and releases all rights to trial by jury in any action or proceeding brought by either party against the other (or its Related Parties) on any matters whatsoever arising out of, or in any way connected with, this Agreement. 24. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original and all of which together shall constitute a single instrument, and shall be effective upon execution and delivery of one or more of such counterparts by each of the parties. Facsimile signatures shall be deemed to constitute original signatures. 25. Time is of the essence. AMERICAN PROMOTIONAL EVENTS, INC. - WEST, ; a California Co oration By: Its: JW1 11L>zen1r SAFEWAY, INC., a Delaware corporation By: K-- � Its : Vice sident By: Its: Form Approved: K: \3rdPartylBNK_DATA\Fireworks \TNT MasterTinal Documents\Firework License Agreement (Safeway) 3 _9_16 v2 GD.doc WWT4657 Safeway 547 10105 224TH GRAHAM WA Yes WWT4662 Safeway 1436 _ 1624 72ND ST E TACOMA WA Yes WWT4687 Safeway 2640 13308 MERIDIAN E PUYALLUP WA Yes _ WWT5250 Safeway 4831 POINT FOSDICK RD GIG HARBOR WA WWT5504 Safeway 3355 BETHEL RD SE PORT ORCHARD WA WWT5754 Safeway 1524 1401 NE MCWILLIAMS RD BEEMERTON WA Yes WWT6249 Safeway 1448 680 -F WEST WASHINGTON SEQUIM WA Yes WWT7105 Safeway 1619 1109 YELM AVE E YELM WA Yes WWT8652 Safeway 1762 1725 PACIFIC AVE WOODLAND WA Yes WWT8812 Safeway 1078 2930 OCEAN BEACH HWY LONGVIEW WA Yes OEH7750 Safeway 1590 455 N COLUMBIA MILTON FREEWATER OR Yes OEH7955 Safeway 371 601 W NORTH ST ENTERPRISE OR OEM8401 Safeway 4469 240 W MONROE BURNS OR Yes OET7204 Safeway 1489 520 MT HOOD ST THE DALLES OR Yes OET8003 Safeway 4381 1205 CAMPBELL ST BAKER CITY OR Yes OWH1195 Safeway 1223 11919 N JANTZEN AVE PORTLAND OR Yes OWH1660 Safeway 1073 6194 SW MURRAY BLVD BEAVERTON OR Yes OWH2O74 Safeway 4387 95 82ND DR GLADSTONE OR Yes OWH2297 Safeway 508 401 A AVE LAKE OSWEGO OR Yes OWH2952 Safeway 1710 1540 MAIN ST SWEET HOME OR Yes OWH3252 Safeway 363 700 HWY 101 FLORENCE OR OWH6564 Safeway 514 642 E THIRD BEND OR Yes OWM1107 Safeway 509 5920 NE UNION (MLK JR BLVD) PORTLAND OR Yes OWM2014 Safeway 782 37601 HWY 26 SANDY OR Yes OWM2020 Safeway 521 20151 SE HWY 212 DAMASCUS OR Yes OWM2109 Safeway 2690 4300 SE KING RD MILWAUKIE OR Yes OWM4602 Safeway 1556 230 E JOHNSON COOS BAY OR Yes OWM6702 Safeway 4316 244 N F ST LAKEVIEW OR Yes OWT1181 Safeway 382 3527 SE 122ND PORTLAND OR Yes OWT1193 Safeway 1451 221 NE 122ND PORTLAND OR Yes OWT1555 Safeway 4510 6745 SW BEAVERTON -HILLS HWY PORTLAND OR Yes OWT2072 Safeway 2696 14840 SE WEBSTER RD MILWAUKIE OR Yes OWT2079 Safeway 2993 13434 COLTON PL OREGON CITY OR Yes OWT2290 Safeway 1047 17779LOWE BOONES FERRY RD LAKE GROVE OR Yes WAC 212 -17- 21509: Location. WAC 212 -17 -21509 Location. Page 1 of 2 (1) CFRS facilities will be permitted only in the county shown on the license. If the county needs to be changed, or other corrections made, the license will be surrendered to the state fire marshal and the state fire marshal will issue a new license for the new county. Any corrections written on a license will void the license. (2) CFRS facilities will only be located at the address for which the permit from the local jurisdiction was approved and placed according to the approved site plan. (3) Activities or uses subject to this rule will not be limited in location except where such activities or uses are prohibited or controlled by local development regulation, traffic safety or road construction standards. (4) The CFRS facilities will not be located more than one hundred fifty feet from a private way, fire department access road, public road, street or highway as measured by an approved route around the exterior of the stand. The minimum requirements for a private way will be determined by the local authority having jurisdiction, but will not exceed the requirements of locally adopted street, road and access standards. (5) Any two CFRS facilities must be at least one hundred feet apart or will be separated by a road, street or highway not less than thirty feet in width. (6) CFRS facilities must be located as follows: (a) The minimum required area surrounding the CFRS facility must be marked or flagged, except that flagging and marking CFRS facility will not block a sidewalk or pedestrian pathway. (b) Flagging need not exceed twenty feet in any direction. Minimum Setbacks and Clearances Buildings Combustibles Tents Parking Stands Storage CFRS Facility 20 feet 20 feet 100 feet 20 feet 100 feet 20 feet Property Line Public Road Motor Vehicle Traffic Fuel Dispensing Devices Bulk Fuel Generator CFRS Facility 25 feet 20 feet 20 feet 100 feet 300 feet 20 feet (7) CFRS facilities will not be located closer than: (a) One hundred feet from any motor vehicle dispensing station, retail propane dispensing station, flammable liquid storage, or combustible liquid storage. Measurements will be taken from the pump, island, or dispensing device above ground tank storage or lids of underground tanks to the CFRS. (b) Three hundred feet from any bulk storage of flammable or combustible liquid or gas, including bulk plant dispensing areas. (8) Penalties for violations of this section are provided in WAC 212 -17 -515. http://app.leg.wa.gov/wac/default.aspx?cite=212-17-21509 06/03/2016 TNT 40 X 20 Tent Layout Exit 5'6" Entrance 8' io :tt LU 4020Tentlayout03 = 8' Table I * = 6' Table (& =Fire Extinguisher F. 3i a `I Q11'..'ertifirate of if fame Reqt".5tance REGISTERED ISSUED BY: Date treated or APPLICATION AZTEC TENTS manufactured CONCERN NO, 490 ALASKA AVENUE �J TORRANCE, CA 90503 0 5'2006 CAL COM13 F- 449.01 (310)325 -5080 This is to certify that the materials described below hereof have been flame retardant treated (or are inher- ently nonflammable). FOR ABC PARTY RENTALS ADDRESS 4333 HARBOUR POINTE BLVD. SW CITY MUKILTEO STATE WA, 98275 Certiriication is hereby made that: (check "a" or " b') (a) The articles described below this certificate have been treated with a flame retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in confor- mance with the laws of the State of CaOifornia and the Rules and Regulations of the State Fire Marshal. Name of chemical used ............. ............................... Chem. Reg. No......................... Meathodof application ................................................................. ............................... F*] (b) The articles described below hereof are made from a flame- resistant fabric or material registered and approved by the State Fire Marshal for such use; Fabric has been tested and passes NFPA701 -96. Trade name of flame - resistant fabric or material ¢used., Larrrinared Fabric . Reg. No. ...... F -A!M The Flame Retardant Process Used W1L_ NOT .. .Be Removed by Washing (WTI or Will no?) David Bradley Name ONNV cararor Pmduc6on uperirrmscWn: CUSTOMER ORDER NO. R160322 ITEMS MANUFACTURED: 2- 40'x40' (2 PC.) .IUMBOTRAC TOP oNLY ULTRA WHITE 3- 40 x20' JUWB0TRAC MIDDLE TOP ONLY ULTRA WHI rE 2- 40 x95' JUMBUTRAC MIDDLE TOP ONLY- ULTRA WHITE 2- 30 x30' (2 PC_) JUMBO TRAC TOP ®LILY- ULTRA WHITE 2- 30 x20' JUMBOTRAC MIDDLE TOP ONLY- ULTRA WHITE 2- 30'x10' JUMBOTRAC MIDDLE TOP ONLY- ULTRA WHITE 31- 10'X-10'(1 PC.) FESTIVAL TOP ONLY- ULTRA WHITE 8- 10 x20' (9 PC.) FESTIVAL TOP ONLY- ULTRA WHITE Chuck Miller - President L-d ZZZLC6t9ZV SjeaUe�j jueA3 lepedS oqV dgo:Co 80 9Z unr No April 13, 2015 Community Development City of Yelm 105 Yelm Avenue West Yelm, WA 98597 Community Development Official, In preparation for the upcoming 2016 4t" of July season, please find enclosed with this letter all the documents to apply for (2) stand /tent fireworks permit. Included with the paperwork are the City of Yelm permitting fees. If you have any questions, please feel free to contact me at (253) 922 -0800, thank you. ,� inherely, Liz L' icl h lisi to i eworics.com Li��rlsi Perrryr�s American Promotional Events, Inc. - Northwes Enclosure(s) Liz Lisicich Licensing & Permitting (253) 922 -0800 American Promotional Events Inc. Cell (253) 906 -7377 2120 Milwaukee Way Fax (253) 830 -2930 Tacoma, WA 98421 lisicichl @tntfireworks.com AMERICAN PROMOTIONAL EVENTS, INC. 2120 MILWAUKEE WAY - TACOMA, WA 98421 TACOMA (253) 922 -0800 - FAX (253) 830 -2930 www.tntfireworks.com p r-Mmg � �' ;;1 0 3 2016 BY