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KITTITAS COUNTY FIRE MARSHAL'S OFFICE <br />411 N. Ruby St., Suite 2, Ellensburg, WA 98926 <br />Office (509) 962-7657 Fax (509) 962-7682 <br />Fire Marshal "Special Event/Assembly" Permit <br />Application Date: Initial ❑ Renewal <br />Permit #: <br />'EcEvent Permit (Temporary) Title of Event: SGL . r C r`.1Q- II' +FLqN <br />Dates/Times ofEvent: // r �1f �G 1j 0 �+ <br />—1-a <br />Physical Location of Event: p-�7 r } v�Vl tg ,p �4 (M ` L C ❑ Indoors Outdoors <br />•L•i3 (j <br />L1 <br />G� <br />Event Coordinator, j j �[►9� <br />vey 't -+ Phone #: �� <br />r, - Ln I i _ t Cell #. '4 C-1 <br />( 1 17I�ZiP`q- <br />Mailing Address � 1 t ' I O�7Y �� ' \.k City ��� i� �"r�.l �lr St Email: �QI t G Fii (I iY? w <br />LJ -Akserubly Occupancy (Permanent) Specific Use of Building: <br />Physical A <br />Building Tenant: I'iwrte Cell #: <br />Mailing Address City St Zip .rn�iil <br />Building Owner: <br />Mailing Address City t Zip Esli <br />Hours �X()pkm iun.Pnf, iieynncri fix Assembly Occupancy Pennils) <br />SUN: <br />MON: <br />TUE: <br />ED: <br />I HU: <br />is <br />S <br />Specific Description of Operation/Event: (Required for both permits) <br />A p'I'f0 Y, t JCO -),o }.?a U &.44 e in pe -e S. v' i vi vi - d4 cavi a vl O JZtj V' F Ise Cep % fes <br />a.0/41l✓05 pi,rt e-acoW,44 <br />-f--aL;Hev1Oee-�- %II'S a✓ o 1Gc✓ pA+reVT1 <br />FoodBeverage?i Y �4NO <br />Alcohol Served? YES NO <br />Live Entertainment? YRS NO <br />Security On Site? YES NO <br />Tents? #of �l/ ` _ NO <br />Stages? #of YES NO <br />Emergency Contact: -rlhun-ef <br />After Hours: Phone #: <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 / Aut <br />Signatea Print Name:)4e <br />Title: LU liePi3one #: f (MA v 4 Z-5 ) — l? <br />� y 7 ❑ate: - r<� %1 �o � ' <br />. <br />Version 2009.2 <br />