HomeMy WebLinkAbout2779_001Kittitas County, Washington
ey BOARD of C OUNTY C OMMI S S IOWR
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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 athtt-v://www.co.kittitas.wa.us/boc/cotintycode/titleD5.ast)
Event Information
Name of event:
Date(s) of even
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Hours of operation: 11"r.3-6 g�fw A'rn _
Description of the event:
Has this event taken place before?Yes No Dates: C�cr(.
Estimated attendance:
How is your event being publicized?� _� tierce %T
Please attach any flyers, posters, etc. with your application submission.
Contact Information
61-44
Name of the organizer/ contact person: e G
Phone number(s): 0- % 3 [,5 Q�) cJ�Z/ 5 f
Email
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Date of birth of applzcartt: / O Z2 7f 1I I eL
KITTITAS COUNTY COURTHOUSE • 205 WEST 5h, SUITE 108 • ELLENSBURG, WA 98926
(509) 962-7508 • FAX (509) 962-7679
www.colittitas.wa.us
If the application is made on behalf of a partnership, please submit full names with their
residence and post office address for a period of six months prior to the date of
application together with the location of principal office or place of business of such
corporation.
Emergency contact name(s) and phone number(s) that can be contacted during the
event:
Name Ph a Number
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WRITTEN PERMISSION TO ENTER EVENT SITE
I/We hereby permit law enforcement and/or County officials to enter the site for which
the Event Application has been granted at the time of the event and up to five days
prior to the event for the purposes of inspecting and enforcement of County Code and
other applicable laws, and pursuant to my agreement and representations made in
connection with this Event Application.
SWORN STATEMENT OF COMPLIANCE
T/ We hereby acknowledge that I/ We have read Kittitas County Code, have
familiarized myself with County requirements. I/ We agree that either my designated
agent or I/we shall be on site at all times and shall be responsible for the operation of
the event and for compliance with all legal requirements in connection with this event.
I/We understand that failure to comply with the rules, regulations and conditions set
forth in Code may be deemed a gross misdemeanor and that drug or narcotics
violations are crimes under RCW.
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Applicant Name( 'int) Applicant Signature
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Applicant dame (Print) Ap&cant'Miginature
K1T1ITAS COUNTY COURTHOUSE - 205 WEST 5h, SUITE 108 - ELLENSBURG, WA 98926
(509) 962-7508 - FAX (509) 962-7679
www.co.kittitas.wa.us
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Kittitas County, Washington
BOARD of COUNTY COMMISSIONERS
Fire Safetv 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 Fire Marshal's
office. You may contact the Fire Marshal's office at 509-962-7000.
Will there be a temporary structure erected for the event? Yes Nom
If yes, you must attach a drawing including the dimensions. The structure may
require an inspection by County staff prior to the event.
Public HealLbAnvironmental Health
Will there be food served at the event? Yes �,, ` (So)
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 ht€ -,-/ 1 www.co.kittitas.wa.usjhealth/ food.asp?
- If yes, please submit an application for exemption 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 serving 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
th permitted pe on or organization.
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If yes, and the person or organization prep and 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 food service permitting process.
KITFITAS COUNTY COURTHOUSE - 205 WEST 5", SUITE 108 • ELLENSBURG, WA 98926
(509) 962-7508 - FAX (509) 962-7679
www.co.kittitas.wa.us
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Kittitas County, Washington
BOARD of COUNTY COMMISSIONERS
Law Enforcement/Securitff mergency Medical Services
Will there be security on site during the event? Yes F-0
If yes, please provide a complete list of names and contact information for who will be
providing the security.
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Will Emergency Medical Services (EMS) be on site during the event? Ye o.�
If yes, please provide written verification from the providers.
Will there be music, sound amplification or any other noise impacts? Yes No
If yes, Kittitas County has a noise ordinance in effect (see County Code for details). If
your event is scheduled for outside of the allowed time, you must submit a written
letter to the Board of County Commissioners requesting a waiver and it must be
included with your application materials.
Will you have traffic control? (!es)No oZ 7
If yes, please provide documentation on how the traffic control will Tbe addressed.
Will there be off-site parki 4g? Yes No a'n 4yr - X-1
If yes, please provide the location and a parking plan.
Will there be shuttle buses provided for attendees? Yes No
If yes, provide a map of their route.
Will there be alcohol served at the event? Ye,�
If yes, a State permit is required from the WA State Liquor Control Board and must
submitted with your application materials. //
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KITTITAS COUNTY COURTHOUSE - 205 WEST 5", SUITE 108 • ELLENSBURG, WA 98926
(509) 962-7508 • FAX (509) 962-7679
www, ca kittitas.wa.us
Kittitas County, Washington
BOARD OF COUNTY COMMISSIONERS
Public Roads
Will the event obstruct, interfere or rthe closure and free use of any public
road, street or right-of-way? Yes?
If yes, please provide a detailed adequate traffic and detour plans at the time of
submission of the application.
Will there need to be road closure or detour signs posted? Yes No
KITTTTAS COUNTY COURTHOUSE • 205 WEST 5", SUITE 108 - ELLENSBURG, WA 98926
(509) 962-7508 - FAX (509) 962-7679
www.co.kittitasma.us
Kittitas County, Washington
BOARD OF COUNTY COMMISSIONERS
Garbage/Reeding
Do you have a plan for garbage and recycling? es No
A written plan for garbage and recycling must be attached to your application
materials. For questions or assistance contact the Kittitas County Solid Waste
Department at 509-962-7542. - /� Q C a ague-, a v &j a k.0 e1 Vur- A �
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il Insurance r
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Have you obtained a Certificate of Insurance and endorsements, specifically
naming "Kittitas County" as an insured? es � No
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A copy of the Certificate of Vance And endorsements 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. This
insurance must apply first and on a primary non-contributing basis in relation to any
other insurance or self-insurance available to Kittitas County.
Penal Bond - Bond of Indemnity
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 damage has been done and that
the County has not incurred additional expenses
Are you submitting a $5,000.00 Pe Bond -Bond of Indemnity with your Event
Application? Yes No
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.
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Countv Filines and Reeistration
Is there a cost to attend the event? de::� _�No X-e'u-0--3
How much are you charging to attend our event?
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KITTITAS COUNTY COUR' NOL .: • 205 WEST S" , surm48 • - .LF.i ,,U,G, WA 989
(509) 962-7508 • FAX (509) 962-7679
www co.kittitas.wa.us
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F "�^'' •� KITTITAS COUNTY Receipt Number: CD18-01278
FIRE MARSHAL
411 N. Ruby St., Suite 2
f Ellensburg, WA 98926
509-962-7000 / www.co.kittitas.wa.us/cds/firemarshal /
Payer/Payee: REPP, SCOTT F ETUX Cashier: KATHY BOOTS Date: 06/05/2018
1570 ROBINSON CANYON RD Payment Type: CHECK (6354)
ELLENSBURG WA 98926
FMO -18-00005 Fire - Oth 1570 ROBINSON CANYON RD ELLENSBURG
Fee ■_ Balance
Fire Permit Issuance $165.00 $165.00 $0.00
FMO -18-00005 TOTALS: $165.00 $165.00 $0.00
TOTAL PAID: $165.00
Printed 06/05/2018 13:13:00 by Kathy Boots Page 1 of 1
Kittitas County Office Of The Treasurer
Brett Wachsmith, Treasurer
-41 205 W 5th Avenue, Suite 102
Ellensbuxg, Wa 98926
Phone (509) 962-7535 Fax (509) 933-8212
Cash Suspense
Receipt Number:
2018-2525 Date: 06/05/2018
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: MANDYR
Receipt Type: CHK
Template: COMMISSIONER;
COMMISSIONERS
Comments:
WESTSTAR TEAM
ROPING MAY 2018 - SEPTEMBER 2018
FundCode
G1Code Description Amount
001
1632171 SPECIAL EVENTS FEE $200.00
Total Amount: $200.00
Kittitas County Treasurer's Office
Submitted By: MANDY ROBINSON
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