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Home My WebLink AboutWestStarJUN 3 P Kittitas County, Washington BOARD OF COUNTY COMMISSIONERS EVENT APPLICATION Thank you for your interest in holding a special event in Kittitas County. Please complete and return this application along with any other materials to the Kittitas County Board of Commissioners at least 60 days prior to the day upon the event is. scheduled. Any misrepresentation in the application materials or deviation from the final agreed upon route and/or method of operation described may result in the immediate revocation of an issued permit. Specifics outlining Event: Permits can be viewed at http://www.co.kittitas.wa-us/tx)c/countycode/titleO5.asp Name of Date(s) o: Event Information Hours of operation:_ I'cW , ,:$e) `- Description of the event: `I- In d My, IS Has this event taken place ore? Ye No Dates: r - Estimated attendance: How is your event being publicized? .L&I _l" Please attach any flyers, posters, etc. with ydur application submission. Contact Information Name of the organizer/ contact person: C Address: J,r- C] )#�o Phone number(s); SSD 1 ' — f Email address: k) + &A Date of birth of applicant: KITTITAS COUNTY COURTHOUSE - 205 WEST 5"', surrE m • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www.colittitas.wa.us 3f the application is made on behalf of a whip, please exit full names with titer residence and post office adds for a period of six manths prior to the date of application tavgether with the locabon of primcgml offim or place of bumness of such corporation. event even genuy c0nh1ctname(5) and phone number(s) that can be conbwbed during the G►. 1. :7, rr .rr r1+r . Vol! 1.. i iY#€:1s_J=i.�;�1't�� . [• 7. Yli�l' ��: �r. I/We hereby permltlaw enfameement and/or Cdunty, aH&jais txa enter the site f+0r whirh the Event Application Ives been granted atthe time of the event and up tan five days prior too the event for the purposes of inspectung and enfi=mnentof County Code and other applicable laws, and pursuant to my agreement and xepresentati ons made M connection with this Event AppluatiorL SWORN STATEMENT OF COM7LUNCE I/We hereby admowledge that I/We have read Mttnfas with Co€m County Code, have myw1f ty . l/We agree that either my designated. agent or I/we shall be on site at all times and shall he responsible f6r the operation of the event and for compliance with an legal requirements in omwecflon with this event, I/ We understand that tb comply with the ruler regulations and conditions set forth in Code may be deemed a gross misdemewmw and that drag or narcotics violations are crines under RCW. 5-1 r a vcrr it rrr r r �rmum 441 114r is Jo R--qDI2 Applicant Name (Prhd) • r � „� .r it . M7NM COUfffy CC UR7 FOM - 206 WEST Y', SUIM log • ffi I WA 98826 iM 94M-7= - FAX (sag} 9Q,76n VAVW _K_jMUs Kittitas County, Washington BOARD O' COUNTY COMMISSIONERS Fire Safe and Protection If more than 50 people are expected at your event, you must complete a separate application process which can be obtained through the Kittitas County Fixe Marshal's office. You may contact the Fire Marshal's office at 509-952-7000. Will there be a temporary structure erected for the event? Yes V) If yes, you must attach a drawing including the dimensions. The structure may require an inspection by County staff prior to the event. Public HealfWnvironmental Health Will there be food served at the event?Iva.1 No If no food will be served at the event then, no permit or application is required. If yes, is the food and beverage that you intend on preparing and serving at the event exempt from permit requirements hU:l /www.co.ldttitas.va:us/heat th/ food asp? - If yes, please submit an application for exern tion from permit and proof of food handlers training to the Kittitas County Public Health Department (KCPHD). If yes, and the food or beverage is not considered exempt from permit, then does the person or organization preparing and searing the food have a food service permit, temporary food service permit, or catering permit from KCPHD? - If yes, please provide a list of foods and beverages that you intend on having prepared and served at the event along with the name and phone number(s) of theQermitted person or organization. If yes, and the person or organization preparin d serving the food does not already have a food service permit_ - Then a temporary food service permit or catering permit will need to be acquired from KCPHD prior to the event. Please allow at least 2 weeks to complete the €rand service permitting process. RVoL ;6 tAIki-VIX, �r tAC, KlrrrrAs coUNPY COURTHOUSE - 2o5 WEST 5*, suffE lob - ELLENSBURG, wA 98926 (509) 962-7509 • FAX (509) 962-7679 wwwxo ldttilammus -- �' KillitasCounty, 1 11 ' 1 1 BOARD op COUNIY COMMSSIONERS i" ii(ir.'.ssita Public Loads Will the event obstruct, Rite rfere or req'w,9 the Closure and free wm of any public road, street or xight-vf way? Yes If yes, please provide a debded adequate traffic and demo, plans at the time of s�nissiou of the application. Will there need to be road closure or detour signs pasted? Yes 46 MUMS CXNJNff COLI RTt} M SS • 245 war sR , StffM 1 os - HULEt4SMpRC WA 98926 (509) 967,7308 - FAX (S" 962-7679 y f 1111t: County, Washington BOARD oF COUNTY COMMSSIONER liIif�u�nii• �. Law EmfOrC9M2R16EMfftffiQM23Ma Medical Services Will there be ;secmdty an site during the event? Vs No If yes, please provide a complete list of names and cantact info3rn-whoa for who will be providing the security. will Medical Services (SMS) be on site g the event? Yes If yes, pleaseprovide written verification from the providers. Will There be m mic, sound amplification or any other noise impacts? �s No If yes, Yjtt itas County has a noise ordinance in effect (see County Code for decals:). If your event is w1wduled fns' outside of the allured flme� you must subnut a wA tten letter iu the Board of County CommisWoners xequesft a diver and it must be uuluded with your appIkation ma#mak AT � WM you have traffic control? V6 No Will there be off-site parldu*? Yes V If yes, please provide The location and a parkizlg plan. WSi there be shuttle buses pr raided far attendees► Yes Wi If yes, provide a map of therer route. Will there be aicahol served at the events No IM j If yes, a Starbe perudt is rquired hom the WA State Liquor Cantrd Board and must submitted with your appUcaticm ma triads_ A& 0'P�,3 maqr' 101"IffM CXM3M SUM- WS WUgj S*,sUrMIM - 443,V (sasl9sa, as • FAX (sn _gW_.7M rKri Kitcitas County, Washington BOARD oFCOUNTY COMM SSIONERS Gama a RM cft Do you have a plan for garbage and recycling Y/s No Y A written plan for garbage and recycling must be attached to your application materials. For questions or assistance contact the Kiititas County Solid Waste Department at 509-952-75422 ry�.C��1ct�uJv r.�, Insurance Have you obtained a Certificate of ErmuAnce, specifically naming "Kittitas County' as an insured? No A copy of the Certificate of Insurance must be included with your application materials. Kittitas County must be named as an additional insured in the amount of $1,000,000.00 per occurrence and $2,000,000.00 aggregate coverage. Penal Bond - Bond of Indemnify A $5,000.00 Penal Bond - Bond of Indemnity is required to be deposited with the County Treasurer to save and protect the streets, pavements, bridges, etc. from damage. The deposit or its balance will be returned once the event has been held and the Board of County Commissioners has certified no damasge has been done and that the County has not incurred additional expenses Are you submitting a $.5,000.00 Penal Bond - Bond of Indemnity with your Event Application?' Yes Y `� if no, you must request a letter in writing to the Board of County Commissioners requesting a waiver to the Penal Bond - Bond of Indemnity and outline the specific reasons why it should not be required of your event 710 a.ci--re Comex Fifigps and Registration Is there a cost to attend the event? Yes 4o How much are you charging to attend your event? $20 donation KmrrAs coumY cotm-rwi is 205 WEST Sm, surm los Err sBuR%wA 98926 (509) 962-7508 • FAX (509) 962-7679 www_w.kit[ims.wa.us Are polni" the'r � n� (w fixed baf r"M f�� Wady available at the location of No If yes, please Provide an estimated attendance for the event, a detailed map that identifies the name and address of the physical fac ity that will �c ili:ties for he event; quantity of trnlette facilities a�vaiilable e> a 9,e dcTr nd dfstance from the event tlIat patrons dust walk. gendex, and tyle If no, please provide an estirmated attendance for the event: roented to the number of portable res�� that will be s iiic it i-oa i n the event that patrons xn�t Wa&, and a service plan to RSure t at the �e from a Mm'tary condi�ition YOu must include the locatim of the that rest.. ont remain in �p/diag�t of the event. Portable restrooms an a !^w P—fal bccr+ .. , Aa., ,12A vu.;& % 4*�Ir Aj dnrox,, ��r�,r.. pow,oA,IS rO bcry, KO ASoourmrooh. 20WWrr. SUrjENog $ „iQWA9A9� (509 9W-7= - FAX (5M 9Q 7679 Www -CQ kiUiw-.►acus Kittltas County Office Of The Treasurer Brett Wachsxnith, Treasurer +A r _ _ .... 205 W 5th Avenue, Suite 102 _�.�__„ ,,, ,•. _ Ellensburg, Wa 98926 Phone (509) 962-7535 Fax (509) 933-8212 Cash Receipts Receipt Number: 2017-4179 Received From: MANDY BUCHHOLZ - DEPUTY CLERK OF THE BOARD II Check Amount: $200.00 Cash Amount: $0.00 Other Amount: $0.00 Total Amount: $200.00 Deputy: GalvanB Receipt Type: CHK Template: Comments: CSR 2017-2942 WESTSTAR RANCH SPECIAL EVENT APPLICATION FEE Date: 06/30/2017 FundCode G1Code Description Amount 001 1632171 SPECIAL EVENTS FEE $200.00 Total Amount: $200.00 Kittitas County Treasurer's Office Submitted By: Brenda Galvan (c) 2002 Cashtax All Rights Reserved www.balancedaction corn