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KITTITAS COUNTY FIRE MARSHAL'S OFFICE 411 N. Ruby St., Suite 2, Ellensburg, WA 98926 , \ US Office (509) 962-7657 Fax (509) 962-7682 Fire Marshal `Special Event/Assembly" Permit ►lication Date:5j 2p 1 Qj ❑ Initial ❑ Renewal Permit #; Event Permit(Temporary) em ora Title of Event: (T P 1•k1trJK„t'!]ts�vatk�:r !(}nly {�cmific�S Ei+r AgSveYbl�Ucaap�trn:y 1'cFn�ita} � - SUN: MON: TUE: WED: THU: FRI: SAT: Specific Description of Operation/Event: (Required for both permits) ` v i b, iff— 6u-iA o rm p-e%r 4 i rq + w , - L-. 'vet i Hva.� U-CAlar:5 - -70b - Food/Deverage? No Alcohol Served? NO Live Entertainment? YES NO Security On Site? NO Tents? #of YES NO Stages? #ofd_ YE5 NO Emergency Contact: Phone #: After Hours: Phone #: 4L�-�O-, 5oq. (p7-4. oafb :30 • 3 5, f I hereby state that the above information is correct. I agree to comply with all requirements related to this Event/Assembly Permit. I further agree to, and hereby grant to the Kittitas County Fire Marshal's Office the bight to enter onto the premises as described for this permit application, for the purpose of making such inspections and tests as may be required. This permit is valid until renewed, revoked, or expired and is non- transferrable. Owner / Auth 'Zed Agent Signature: Print Name: p GM�� Tit. e' E,XC..,U-hV Version 2009.2 ?__o rS' d (vpl't.� t ��- EnG{S c�- I D�t►.1 Physical 1.0calion of Event: 2,� I � �/ ,o p Y-� �e CLL l�t�- (UWL P" �A ❑ V� %�v� Indoors Outdoors Event Coordinator; Iru� l Phone #: �•^Gj . ` . �2 I „ Cell Mailing Address �]/� city `�IV ;& { St,YVA ZZi P 28�- Eimai [ 171 YQ ! ❑ Assembly Occupancy (Permanent) Specific Ute of kiilding: Physical Address; Assessor's Map #: Building`foumu Phone #: 4CCU #: — Mailin Address g City St Zip Email: Building Owner: Phone #: Cell #: Mailing Address City St Zip Email: 1•k1trJK„t'!]ts�vatk�:r !(}nly {�cmific�S Ei+r AgSveYbl�Ucaap�trn:y 1'cFn�ita} � - SUN: MON: TUE: WED: THU: FRI: SAT: Specific Description of Operation/Event: (Required for both permits) ` v i b, iff— 6u-iA o rm p-e%r 4 i rq + w , - L-. 'vet i Hva.� U-CAlar:5 - -70b - Food/Deverage? No Alcohol Served? NO Live Entertainment? YES NO Security On Site? NO Tents? #of YES NO Stages? #ofd_ YE5 NO Emergency Contact: Phone #: After Hours: Phone #: 4L�-�O-, 5oq. (p7-4. oafb :30 • 3 5, f I hereby state that the above information is correct. I agree to comply with all requirements related to this Event/Assembly Permit. I further agree to, and hereby grant to the Kittitas County Fire Marshal's Office the bight to enter onto the premises as described for this permit application, for the purpose of making such inspections and tests as may be required. This permit is valid until renewed, revoked, or expired and is non- transferrable. Owner / Auth 'Zed Agent Signature: Print Name: p GM�� Tit. e' E,XC..,U-hV Version 2009.2