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KITTITAS COUNTY FIDE MARSHAL'S OFFICE 411 N. Ruby St., Suite 2, Ellensburg, WA 98926 Office (509) 962-7657 Fax (509) 962-7682 Fire Mi arshal "Special Event/Assembly" Permit Application Date: ❑ Initial ❑ Renewal Permit: 21 Event Permit (Temporary) Title of Event: O �^e .--r`� Dates/rimes of Event: —i • ` r� I,FI 20l°I ►'"S 0—+ 1 P" t C.61-�C.lz.� t >�Ip(� e� j ppM Physical Location of Event: 2 f ., tQ _ . . , 1) r' %(e -, e �Um �u[J 1�1CJLJCd ► '� I WA -76V,�L ❑ Indoors WOutdoors Event Coordinator : j -C Phone r t I n phone #: jj �7L 5 • 692 . -q3 I v Cell M. 2�9-572 .5�Sco Mailing Address .2 city - I? StWA- ziPC7n41e. t —it- •rr ❑ Assembly occupancy (permanent) PDysicat Ad&r4s: MgTt i : Maift Addm a Bsriklisrg Uwtfcr: Mailing Addmr s SUN: I MON: I TUE: 4miriic the of Building: ASMWs Map #: Phone #: city Phone #: City Cell #: St zip Email: Cell #: St zip Email: WED: f THU: I PRI: SAT: Specific Description of operation/Event: (Required for both permits) C t�'S - glad Food/Beverage? No Alcohol Served? S No Live Entertainment? YES NO Security On Site? NO Tents? #of YES NO Stages? #of _� YES NO Emergency Contact: Phone #: After Hours: Phone #: �•3�S.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 Marshals Office the right 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, transferrable. or expired and is non - Owner /Authorized Agent Signature: V'J Print Name: i7 Title: f Y� Phnue :a2- - 731 L not Version 2009.2