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If the application is made on behalf of a partnership, please submit full names with their <br />residence and post office address for a period of six months prior to the date of <br />application together with the location of principal office or place of business of such <br />corporation. <br />Emergency contact name(s) and phone tiumber(s) that can be contacted during the <br />event: <br />C.ax <br />Name � � � Phone Number 'Z <br />p c c <br />Name Phone Number <br />WRITTEN PERMISSION TO ENTER EVENT SITE <br />I/ We hereby permit law enforcement and/or County officials to enter the site for which <br />the Event Application has been granted at the time of the event and up to five days <br />prior to the event for the purposes of inspecting and enforcement of County Code and <br />other applicable laws, and pursuant to my agreement and representations made in <br />connection with this Event Application. <br />SWORN STATEMENT OF COMPLIANCE <br />I/We hereby acknowledge that I/We have read Kittitas County Code, have <br />familiarized myself with County requirements. I/We agree that either my designated <br />agent or I/we shall be on site at all times and shall be responsible for the operation of <br />the event and for compliance with all legal requirements in connection with this event. <br />I/We understand that failure to comply with the rules, regulations and conditions set <br />forth in Code may be deemed a gross misdemeanor and that drug or narcotics <br />violations are crimes under RCW. <br />V <br />Applicant Name (Print) <br />'W4411e Lptar) <br />Applicant Name (Print) <br />& A -A _bV, , <br />Applicant Si ature <br />,�VQ t4` -- <br />Applicant Signature <br />KITTITAS COUNTY COURTHOUSE • 205 WEST 5" SUITE 108 - ELLENSBURG., WA 9.8926 <br />(509) 962-7508 • FAX (50�) 962-7679 <br />www.colittitas.wa.us <br />