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KITTI'TAS COUNTY FIDE 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/Assetnbiy" Permit <br />Application Date: <br />0 Event Permit (Temporary) <br />Dates/rimesofEvent: ZOIQ <br />Physical Location of Event: 'AD <br />1 �Q <br />Event Coordinator : Jv <br />!-fit <br />Mailing Address 'rte v -y A <br />13 Initial W ❑ Renewal - Pennit #1: <br />Title of Event: Erie, 1 r� e 1I wpb•, <br />��■.7 PVI.[ + <br />!WA ❑ Indoors <br />`am Phone #: C` J 1 85 .3 (V Cell #: <br />City ✓ r <br />--- - �{ N 11 StYVA- Z'po,, .1 i i <br />❑ Assembly Occupancy (permanent) <br />PhysicalAddress; <br />8uildirtgTeaoni <br />Mai ft Address <br />Building Owuyer : <br />Hlailing Address <br />SUN: 'MON: TUE: <br />Slkcifk We of Ilsrilding: <br />Assessor'N Map M: .. <br />Phone M Cell #: <br />City St Zip Email: <br />Phone M Cell #: <br />City St Zip Email: <br />�U <br />WED: THU: I PRI: <br />Specific Description of Operation/Event: (Required for both permits) <br />.- fsJ+ Mcl <br />WOUtdoors <br />SAT: SAT: <br />tvy i Hvo,+eMs tars-- . <br />S ^ <br />FoodBeverage? No Alcohol Served? S NO Live Live Entertainment? YES NO <br />Security On Site? No Tents? #of YES No Stages? #of_YES No <br />Emergency Contact: Phone #: After Hours: <br />Phone #: <br />30 PM 03. 375. l <br />pl <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 / Authorized Agent <br />t <br />Shgonature: Print Name: p <br />Titl �� -hot <br />5b� J 7 3I C) Mi, - <br />version 2009.2 <br />