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If the application is made on belhalf of a partrtmbip, please submit#ull names with their <br />residence and post office address for a period of sic mond-ts prior to the date of <br />application ixmgether with the location of principal office or place of business of such <br />corporation_ <br />Emergency ccntactname(s) and phone m mober(s) that can be contacted dig the <br />,:L -,-� 0 0 1 C-)�, 5) -0 <br />Name I Phone Number <br />Name <br />Phone Number <br />WRITTEN PERMISSION TO ENTER EVENT SPPE <br />I/We hereby pemUtlaw'eoforcementand/or County offidals to enter the site for which <br />the Event Application has been granted at the time of the evert 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 may agreement and represe>ataik ms made m <br />connection with this Event Application. <br />SWORN STATEMENT OF CONDI I.IANCE <br />I/We hereby acknowledge tfiatI/We have road Ki.Hrtas county Code, have <br />familiar� znYself with County its_ I/We agree that eithermydesignated <br />agent or I/we shah be on site at all times and shall be responsible for the operation of <br />the event and for compliance with all legal requirements iia connection with -am event <br />I/ We prudersbnd that failure to, comply with the rales, regulations and conditions set <br />forth m Code may be deemed a gross misdemeanor and that drug or narcotics <br />violations are times under-RCW. <br />&b -Do Id <br />Appliemt Na6e (Print) <br />Lenvire- T)o [ Qk')i*'cn <br />Applicant Name (Prifit) <br />Applicant Signature <br />Applicant 5" e <br />1UWf1AS CUU?B YC0URMWE- M WMr, SUrM log - EUMSBURGy WAM6 <br />M962-7509 - FA3 (iM 962-7679 <br />www -ca iar►i as.wa.us <br />