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KIT'TITAS COUNTY FIRE MARSHAL'S OFFICE <br />00 411 N. Ruby St., Suite 2, Ellensburg, WA 98926 <br />Office (509) 962-7657 Fax (509) 962-7682 <br />Fire Marsh al "Special Evert/Assembly's Permit <br />Application Date: <br />• Event Permit (Temporary) <br />Dates/rimesof 1] nt: <br />Physical Location of Event: <br />J <br />Event Coordinator: I �'(J <br />Lp <br />Mailing Address T - k, ,r -N -A 011 r. <br />❑ Initial ❑ Renewal <br />Pernlit #1: <br />ritle of Event: E+0 C 1 ; <br />)pVS Qf (P pw( *- VDYI CL v f ee� a_-+ p <br />ri V2, UL E(UWL WA':6t19_ ❑ indoors 'Outdoors <br />Phone #: Cell q: 2— .575to <br />City 1'1 <br />St ,wA- ZiP Sinai F <br />�w� <br />❑ Assembly Occupancy (Permanent) Specific Use of Building:- <br />Physital Adm; Asstm6t Map <br />Baiiding'Fenaat ; Phone #: — <br />Cell d: <br />Mei ft Address City St <br />Zip Email: <br />Building owner Phone #: <br />Cell #: <br />Mailing Addrm City St <br />zip Email: <br />SUN: � MON; � TUE: � WED: TM: <br />SAT: <br />Specific Description of Operation/Event: (Required for both permits) <br />Food/Beverage? NO Alcohol Served? No Live Entertainment? YES Na <br />Security On Site? is NO Tents? #of YES No Stages? #of L-- YE No <br />i nicrgenuy Cd>ssact: Phone #: After Hours: Phone #: <br />Let, ]cam cu ar JD04?- 04. OfD ;em <br />30 <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, forth purpose of making such <br />transferrable. <br />inspections and tests as may be required. This permit is valid until renewed, revoked, or expired and is non - <br />Owner / Aut4grized Agent <br />Signature: r Print Name: C)C-7 <br />Title. vc A Phone f�D-1 �3 D 0 <br />Version 2009.2 <br />