Laserfiche WebLink
KITTITAS COUNTY FIRE MARSHAL'S OFFICE <br />411 N. Ruby St., Suite 2, Ellensburg, WA 98926 <br />r Office (509) 962-7657 Fax (509) 962-7682 <br />Fire Marshal "Special Event/Assembly" Permit <br />Application Date: 3 r;z jki � ❑ Initial ❑ Renewal <br />permit #: <br />34 Event Permit (Temporary) Title of Event: 2vri� _ 1 ; '� <br />okA <br />Dates/Times of Event: e) <br />z0(—+ C(Covs bpe*V 0.,+ U 0A t Cz))C ` U a4- 17pq <br />Physical Location of Event: p, ,.,,, Ride* iYGI �� E Ivm, v�/� 985 ❑ Indoors Outdoors <br />+�►N <br />Phone #: 5!`ct - t952 t O Cell #: 0 . 5� f ' <br />-7-Z <br />Event Coordinator ; OJD1 V �.P <br />Mailing Address `o � 2 City n , <br />St Wa Zip GQ �jTl Email: Ali <br />❑ Assembly Occupancy (Permanent) Specific Use of Building: �S /C7 � <br />Physical Address: Assessor's Map <br />Building Tenant; Phone #: Cell #: <br />Mailing Address City St Zip Email: <br />Building Owner: Phone #: Cell #: <br />Mailing Address City St Zip Email: <br />Horlrsot'tlperakioli; {Only 141g11 i(M for Assemhly Oct:isj1 Oy Penwits) <br />SUN: <br />MON: TUE: <br />WED: <br />THU: <br />FRI <br />SAT: <br />Specific Description of Operation/Event: (Required for both permits) <br />0'4, ave"U"A&A Leco - 0Akr0-"&: <br />Food/Beverage? YE5 NO <br />Alcohol Served? YES NO <br />Live Entertainment? 'ES NO <br />Security On Site? s NO <br />Tents? #of YES NO <br />Stages? #of_L 1'I S NO <br />1i1uwrgcncyCantact Ph,,jw tl <br />!~tea, i� ja- l (o ff - . (0 51 <br />After Hours: Phone #: <br />30ip A cjC�j. 1814 <br />I hereby state that the above information is correct. I agree to comply with all requirements related to this <br />Event/Assembly Permit. I further agree to, and hereby grant to the Kittitas County Fire Marshal's Office the <br />right to enter onto the premises as described for this permit application, for the purpose of making such <br />inspections and tests as may be required. This permit is valid until renewed, revoked, or expired and is non- <br />transferrable. <br />Owner / Autborized Agent <br />Signature: Print Name: <br />'itle: t fie- Phone . �� • �.. Date: 2� <br />Version 2009.2 <br />a <br />