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20170123 Permit Pkg 02132017City 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: 17100 SR 507 SE Permit No.: 20170123 Issue Date: 2/13/2017 (Work must be completed within 180 days) Phone: 253 - 922 -0800 Owner: JESUS NAME PENTECOSTAL CHURCH Assessor Parcel No.: 64303101001 Subdivision: Contractor Information: Name: AMERICAN PROMOTIONAL EVENTS NW Phone: Address: 2120 MILWAUKEE WAY TACOMA WA 98421 Contractor License No.: Expires: 12/31/2017 Project Information: Project: FIRE WORKS Description of Work: JUNE 28 THRU JULY 4, 2017 Sq. Ft. per floor: First Heat Type (Electric, Gas, Other): Second Third Garage Basement Fees: Item Contractor FIRE AMERICAN PROMOTIONAL EVENTS NW TOTAL FEES: Applicant's Affidavit: I cert ify (ts t I have read and examined the forma on contained within the application and know the same to be tru nd co o certify th th ropos structure is in conformity with all applicable City of Yelm re ati s including hose gov ng nd land subdivision, and in addition, all covenants, easeme arestrict ion of reord If ppl irjg as contractor, I further certify that I am currently registerin h �ta�e i to I A _ '1_4-� . Firm Lot: Fees $ 30.00 $ 30.00 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: Cite of Mm (36 i) 458 -3244 REC*: 00259488 2/13/2017 10:01 AM OPER: CO TERM: 001 REFS` : 30047801 PAID 8Y: TRAM: 33.0000 BUILDING PERMIT'S 20170123 30.O(CR AMERICAN PROMOTIONAL EVENTS NUJ 17100 SR 507 SE FIRE 300CR TENDERED: 30.00 CHECK. APPLIED: 30.00 - CHANGE: 0.00 FlREN� RKS January 26, 2017 Community Development City of Yelm 105 Yelm Avenue West Yelm, WA 98597 Community Development Official, 20►l Ol'a� In preparation for the upcoming 2017 4th 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 an questions, please feel free to contact me at (253) 922 -0800, thank you. Si�nce�el acii 'ch t ' ';ewo �ks. c o & its American Promotional Events, Inc. - Northwest Enclosure(s) AMERICAN PROMOTIONAL EVENTS, INC. 2120 MILWAUKEE WAY • TACOMA, WA 98421 TACOMA (253) 922 -0800 • FAX (253) 830 -2930 www.tntfireworks.com Di 111 13Y- _________ ____ ___ _ _ __ N%NGTO,V $?,- Washington State Patrol Fire Protection Bureau �k. Office of the State Fire Marshal CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE *qRS „A�g��`' Stand Number: SN -1108 ` Licensee Data Operational Data American Promotional Events, Inc. Wholesaler: TNT Fireworks 2120 Milwaukee Way County of Operation: Thurston Tacoma, WA 98421 Operates For: Yelm Jesus Name Pentecostal Ch, License Number: WSPFL -02766 Stand Operated B Phone Number: (253) 922 -0800 p y' Greg Mattock Date of Issue - January 17, 2017 Date of Expiration: January 31, 2018 Consumer Fireworks Retailer Licenses issued after May are ONLY valid for New Years Sales' 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 PO 7l 4e,,,, FIRE PROTECTION BUREAU FIREWORKS LICENSING PROGRAM PO Box 42600 ■ Olympia WA 98504 -2600 •+�.�°`` (360) 596 -3914 FAX: (360) 596 -3934 Mr. APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWT7150 TO Governing body of city, town, or county in which DATE OF fireworks stand will be located. APPLICATION JANUARY 26, 2017 Applicant Name Address, City, State JESUS NAME PENTECOSTAL CHURCH 2120 MILWAUKEE 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 location[ 17100 SR 507 SE, YELM WA WALMART #3705 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: 2017 (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 4`h Sales for December 31s` From: JUNE 28, 2017 From: To: JULY 4, 2017 To: Sponsor GREG MATTOCKS L0ca110 eALMART #3705,17100 SR 507 SE ls/ I�yl., L . ��.��I --� /S/ j k �� ,(� ,11_ FOR GREG MATTOCKS Signature of Official Granting Permit Title ,���� o>,J c, -y- Frc J.OF A i Date Z - Jb - i 7 Permit Number Licensee Name JESUS NAME PENTECOSTAL CHURCH 3000 - 420 -013 (R 3/09) License Number 17 -0120 ACORO® ��. CERTIFICATE OF LIABILITY INSURANCE I1/l/2017 1 DATE (MM/DD/YYYY) 1/26/2017 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 have ADDITIONAL INSURED provisions or 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 3280 Peachtree Road NE, Suite #250 Atlanta GA 30305 (404) 460 -3600 CONTACT NAME: PHONE FAX C No Ext : A/C No): E -MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Everest Indemnity Insurance Company 10851 SI8GL00242 -161 INSURED American Promotional Events, Inc. 1359629 DBA TNT Fireworks, Inc. INSURER B: EACH OCCURRENCE INSURER C: INSURER D: $ 500 000 P.O. Box 1318 4511 Helton Drive Florence AL 35630 INSURER E : INSURER F COVERAag ` CERTIFICATE NUMBER: 179149 ?4 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 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 /YYYY MM/DDY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y N SI8GL00242 -161 11/1/2016 11/1/2017 EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED PREMISES Ea occurrence I $ 500 000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 '000 ,000 POLICY I PRCT � LOC PRODUCTS - COMP /OP AGG $ 2 000 000 $ OTHER: AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT Ea accident $ XXXXXXX BODILY INJURY (Per person) $ XXXXXXX ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ XXXXXXX PROPERTY DAMAGE Per accident $XXXXXXX HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $XXXXXXX UMBRELLA LIAB HCLAIMS-MADE OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX EXCESS LIAB DED RETENTION $ $ XXXXXXX WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE NOT APPLICABLE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA E.L. DISEASE - EA EMPLOYEE $ XXXXXXX IIf y a, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 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. PROPERTY LOCATED AT WALMART 17100 SR 507 SE YELM WA (WWT7150) 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 12934924 CITY OF YELM 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 749 ACCORDANCE WITH THE POLICY PROVISIONS. YELM WA 98597 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988 -201,9 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Walmart Independent Sales Organization (ISO) Access Letter TNT Fireworks to scope parking lot space and sell fireworks T( American Promotional Events, Inc. D.B.A. TNT Fireworks Walmart Services 01/02/17 RE: TNT Fireworks to scope parking lot space and sell fireworks Dear Valued ISO, Thank you for your continued support and collaboration. Upon arrival at the store where the event/promotion will occur, this access Letter ("Letter ") should be provided to store management. This letter shall serve as proof that you are authorized to enter the store and complete the parking lot scoping and execution of a temporary firework stand as a promotion /event for the time period specified below. You are also authorized and required to obtain the proper permitting as required by the local city, county, and /or state. Only your employees (collectively "Representatives ") may perform the promotion on your behalf. Your Representatives must produce credentials to store management showing that the Representative has been authorized by you to perform the promotion on your behalf. Scopinq Timeline: Scope work may happen anytime from January 01, 2017 — July 31, 2018 Sales Timeline: Parking lot sales may happen anytime from June 15, 2017 — July 31, 2018 Store Associate (Management) Responsibilities: 1) Allow and agree upon space with TNT Fireworks to sell fireworks on the parking lot during the Independence Day season 2) Customers and employees of TNT Fireworks may have access to restrooms in Walmart facilities 3) For other questions call Walmart Field Support at 1- 700 - Walmart 4) Keep a copy of this LOA for your records This particular program does NOT violate the Walmart Corporate Solicitation Policy. Best regards, se Danielson Manager Il, WM Services Anne Jdhnso Directs (mart Services SITE DIAGRAM ite Drawn: March 17, 2008 Address: 17100 State Route 507 SE Store /Center: Wal -Mart Superstore City &State: Yelm, Washington Cl� 115CR Cross Streets: GPS Co- ordinates 46.56.003 N 122.37.725 W c U. Im Light House Entrance Ch 0 _ �o a m a Loc NO: WWT -7150 Ordinance of: City of Yelm Parcel 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 Tire & Lube Main Entrance Grocery Garden Center Wal -Mart is0,+ C>3 40' e - °� -� 30' E A \ 0 [20:X40 Tent Trellis � Brick Wall Light Sidewalk sidewalk - - -- _.. -------- - - - - -- -------- - -- ------------------------------------- HWY 507 Open Field U c s W CIF" co W CN M V / . x w 69 I!X3 ZZ M «6,9 I!X3 V J co W 0- cn TM W ui L Cfi -F+ x W L UL E0' WMW Ifi �J �•1 M O C6 C CD O N O V IFY4 =_ QC."exttficate of tamr Rvg��t�c�ce REGISTERED ISSUED BY: Date treated or APPLICATI[CM AZTEC TENTS manufactured 490 ALASKA AVENUE CONCERN TORRANCE, CA 90503 0512006 CAL COMB F-419.01 (310)328-5060 This is to certify that the materials described below hereof have been flame retardant treated (or are inkier. antly nonflammable), FCR ABC PARTY RENTALS ADDRESS 4333 HARBOUR P01AfTE BLVD. SW KILTE0 STATE -El CITY MU — - WA 98275 Cerfirication is hereby made that. (chock "a" or "b'q (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 California and the Rules and Regulations of the State Fire Marshal- Name of chemical used ............. ............................... Chem. Reg. No.... ...... ........ Meathodof application ................................................................................................ -j (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 cf flame- resistant fabric or material Used- Reg. No. ...... f:-�! M-1 ...... The Flame Retardant Process Used.Wi�.�-.A9T.... Be Removed by Washing �will or will not) David Bradley Chuck Miller - President 7, Production Supernten�den: 'rifle Name cl` AppUcat� 7 5 CUSTOMER ORDER NO. 8160322 ITEMS MANUFACTURED: 2- 40 x40' (2 PC.) JUMBoTRAc Top ONLy- ULTRA WHITE 3- 40'x20'JUMBOTRA C MIDDLE TOP ONLY ULTRA wHIrE 2- 40'XIO'JUMBOTRAC MIDDLE TOP ONLY- ULTRA WHITE 2- 30'x30'(2PC-) JUMBO TRAC TOP ONLY- ULTRA WHITE 2- 30'X20'JUMB OTRA C MIDDLE TOP ONLY- ULTRA WHITE 2- 30'x10'JUMBOTRAC MIDDLE TOP ONLY- ULTRA wHrTE 31- 10'XI0'(1 PC.) FESTIVAL TOP ONLY- ULTRA MjITE 8- 1® x20'(1 PC.) FES TJ VA L TOP ONLY- ULTRA Wf4j TE 6-d ZZZ1C6tqZt7 Sje;Ue6 ;U8A3 lepedS oqV d80 E0 80 qZ unr RE: Tent Security, Flame Resistance • The certificates of flame resistance. There is one for the red material and one for the white material used in the tent. Each of the tents will also have a tag attached noting that it is flame resistant. • As for security, when the tent is not open for business, there will be at least two people at each tent throughout the night. THEY WILL NOT BE SLEEPING. They will have a cell phone as well as an air horn to scare anyone who may attempt to break in. These tents will also remain lit -up throughout the night. There will not be a fence around the tent, but we do rope off 20ft. away from the tent all the way around the tent, with bright colored pennants. o This plan is valid for all 20x30, 20x40, 30x50, and 40x60 tents. e $ Certlf trate of 11ame ire m9 p REGISTERED lssugD BY Fabric loo° oat. 12-20-95 d i an M a n u F r c r u r i n �onv€a— spurted ¢ oq a P 505(1 PO 1 r A, Eq��yc� � f=- 306.131 MF�mntiic� -3 TN 38 157 r43•d. This is to certify that the McfGricls described on tho reverse side hereof have been flare_ retardanf treated (or are inherently nonflammable), FO Ke Manufaccurin 2 & R e n t I CITY Brooks ADDRESS _5030_ Rock da 1 F St N - STATE---? R__ — COrPif"cation is hereby: made that: (Check "C" or „b") - - -- (a) The artidos des.eribed on the reverse side of ¢his Certificate ho '#e beoh treated with a florne.retaed.., 6orhical approved and registered by the State Fire was done in conformance with the laws of the Sta ®rshal and that the application of said chemical the State Fire 9'lorshal. Pe of California and the Rules and Rogulaiions of Noma of chemical us8d .............. Meth od of application err_ R, ),g, No ........... ,........ () Th® earSiela-a d6sr-ribOd an P}se rorvtze side her+raof a ° .__.._._ °....- o,,,................... roglstera-d and a are rnodh from a floM—r®slsfont fabric or naoterial ppresv¢ad by tfm Stella fire Marshal foc acr+� tree. Trade name of flame resistant fabric °. Group • .. ... ... ....... ...._......... Pilo. -Mi ]60S The Flame Retardant Process .�,t. a nq &e � „4 „.;� Be RemOved By Washing JIMMIE ROBERTSON By A1W+�e of <tgaardcvtar or Prudvcripry Sugssiesfandvnr y 2 11 _ f r;rjv CONTROL NO. 14924 CUSTOMER ORDER NO, 4 2 2 i CUSTOMER INVOfCE NO, 80222 YARDS OR QUANTITY 760 yards COLOR red ST'YL� —Apex II �hrorne DATE PfROCESSE® 9- 11-96