HomeMy WebLinkAboutCascade Challenge Special Event Appiltj
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*n'f HH"?,$$,T".*,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. A.y 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 htto: / / www.co.kittitas.wa.us boc coun fvcode/title05 asn
Event Information
Name of event:
Date(s) of even 0
rY-\Hours of operation:
Description of
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the event: Orcqrrytizerl . r, O\lr\04+i+rVg C \o-u., r JChcto'rL{^\ €-tr-n-F'J,J
Has this event taken place before?
Estimatedattendance, \CIO * t5C)
How is your event being publicized?
No Dates:
Please attach antl flyers, posters, etc. utith your application sttbtnissicrrr.
Contact Information
Name of the organizer f contact
Ad SC
Phone number(s)
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Email ad \f\
Date of birth of applir:ant:\\- R-1q
KI]]]TAS coLrNTy couRrItoIJsE . 205 w BST th , suiiE lOit FII-LENslluRc. wA 98926
(509) 9(;2.750tt FAX (509) 96?--7679
ww\V.co.ktttitas.\r,a.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:
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Name J J Number
Name Phone umber
WRITTEN PERMISSION TO ENTER EVENT SITE
I/We hereby permit law enforcement andf 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
l/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
Applicant Name (Print)Applicant
Applicant Name (Print)Applicant Signature
KITTITAS couNTy couRTHousE . 205 WEST $, surrg 108 ELLENSBURG, wA 98926
(509) 962-7508 FAX (s09) 962-7679
w.co.kittitas.wa-us
4
Kittitas County, Washington
BOARD oF COLINTY COMMIS SIONERS
Fire Safetv and Protection
If more than 50 people are expected at your event, you must complete a separate
application process which can be obtained through the Kittitas County Fire Marshal's
office. You may contactthe Fire Marshal's office at509-962-7000.
Will there be a temporary sfuucture erected for the event? Yes
If yes, you must attach a drawing including the dimensions. The structure may
require an inspection by County staff prior to the event.
Public Health/En vironmental Health
Will there be food served at the event?No
If no food will be served at the event then, no permit or application is required.
If yes, is the food and beverage that you intend on preparing and serving at the event
exempt from permit requirements http://www.co.kittitas.wa.us/health/food.asp?
- If yes, please submit an application for exemption from permit and proof of food
handlers training to the Kittitas County Public Health Department (KCPHD).
If yes, and the food or beverage is not considered exempt from perrnit, then does the
person or organization preparing and serving the food have a food service permit,
temporary food service permit, or catering permit from KCPHD?
- If yes, please provide a list of foods and beverages that you intend on having
prepared and served at the event along with the name and phone number(s) of
the permitted person or organization. l\\ngrs Erla$s*o:*e-^r rvrrl
If yes, and the person or organization preparing and serving the food does not u#"uay
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.
KITTITAS couNTy couRt'HousE . 205 WEST ih, strrE t08 ELLENSBIJRG, wA 98926
(509) 962-7s08 FAX (509) 962_7679
www. co. ki rti tas.wa. us
Yes
Are there permanent or fixed bathroom facilities already available at the location of
the event?
Yes
If yes,please provide an estimated attendance for the event, a detailed map that
identifies the name and address of the physical facility that will provide lavatory
facilities for the event, quantity of toilette facilities available for each gender, and the
distance from the event that patrons must walk.
If no, please provide an estimated attendance for the event, specific information
related to the number of portable restrooms that will be provided, the distance from
the event that patrons must walk, and a service plan to ensure that sani-cans remain in
a sanitary condition. You must include the location of the portable restrooms on a
map/ diagram of the event.
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KITTITAS CoTTNTY COURTHoUSE 205 V/I]ST f\, srrne IO8 ELLET,ISBURG, wA 98926
(509) 962-7s08 FAX (s09) 962_7679
www.co.kitti tas.wa.us
Kittitas County, Washington
BOARD o. CO(JNTY COMMIS SIONERS
Medical S
Will there be security on site during the event? Yes
If yes, please provide a complete list of names and contact information for who will be
providing the security.
Will Emergency Medical Services (EMS) be on site during the event? Yes
If yes, please provide written verification from the providers.
Will there be music, sound amplification or any other noise impacts?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? Y
If yes, please provide documentation on how the lraffic control will be addressed
Will there be off-site parking? Yes
If yes, please provide the location and a parking plan.
Will there be shuttle buses provided for attendees? Yes
e
If yes, provide a map of their route.
Will there be alcohol served at the event?No
If yes, a State permit is required from the WA State Liquor Control Board and must
submitted with your application materials.
KrrrrrAs coIJNTy couRTHousE 205 wEsr $, surrp 108 ELLENSBURG, wA 98926
(509) 962-7s08 FAX (s09) 962-7679
www.co.kittitas.wa.us
Kittitas County, Washington
BOARD oF' COLINTY COMMISSIONERS
Public Roads
Will the event obstruct, interfere or the 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
KIT"TITAS couN'ry couRTr{ousE ' zos wEsr $, surrE 108 ELLENSBURG, wA 98926
(509) 962-7s08 FAX (s09) 962-7679
www-co.kittitas.wa.us
*
Kittitas County, Washington
BOARD OF COUNTY COMMISSIONERS
GarbageAtecycling
Do you have a plan for garbage and recycling?No
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Insurance t-o fvztsh |5lPtvrp\*er
eDtr,rnPs\er
Have you obtained a Certificate of v
naming "Kittitas Count5l" as an insured?No
A copy of the Certificate of Insurance amd endorsem.ents must be included with your
application mate:rials. Kittitas County must be named as an additional insured in the
amount of $1,000,000.00 per occurrence and $2,000,000.00 aggregate coverage. This
insurance must apply firbt and on a primary non-contributi-n-g b6sis in relation to any
other insurance or self-insurance available to Kittitas County.
Penal Bond - Bond of Indemni$
A $5,000.00 Penal Bond - Bond of Indemnify is required to be deposited with the
County Treasurer to save and protect the streete, paverurents, bridges, et'c. frorn
damage. The deposit or its balance will be returnc'd once the event has been held 'rmd.the Board of County Commissioners has cer:tified no damage has been done ancl that
the County has not incun'ed additional expenses
Are you submitting
Application?
Is there a cost to attend the event? Yes
How much are you charging to attend your event?
a $5,000.00 Bond - Bond of Indemnity with your Evenf.
Yes
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.
County Filings and Regishation
No
KITTITAS couNly coURTHOUSE ' 205 wtisr Jh, SUITB 108 ELLENSBUR.c, wA 98926
(s09) 962-7508 F,^.X (509) 962-7679
www.co.kitl.itns.vra.us
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Liquor and Cannabis Board
Washington State Liquor Cannabis Board
BANQUET PERMIT
(Dscsnot Authorize Sale of Alcohol)
Document Number: LGB-BP233112
Name of Organization (if applicable): bl.'\-r.72Hed{iic€t€n€ku€tk'n+t€i- loat fr r ABANC+I, Ul-C'
Start Date of Event:
Jun 11, 2022
Applicants Name:
Richard Hoyt
Phone Number:
(509)304-5002
Event Start Time:
5:00 PM
Applicants Home Address:
po box 814 South Cle Elum WA 98943
Event End Time:
10:00 PM
Name of Building or Location
Lost Pair Ranch
Room or Area Held
outside shop
NumberofEvent Days: 1
Street Address of Building or Location:
3900 Pasco Rd
City of Building or Location:
CLE ELUM
County of Building or Location:
Kittitas
Purpose of Occasion (be specific): Banquet after sporting event for awards
Number of Persons to Attend: 75 Number of Persons Under 21 Years of Age That Will Attend: 5
Attendees WLL NOT bring their own Alcohol.
Name of Gaterer:Address:Phone:
I have accepted this permit subject to following conditions:
THE EVENT WILL NOT BE OPEN TO THE PUBLIC. No advance sale of tickets will be made to general public and no advertising will
be directed to the general public.
Liquor will not be sold for cash, scrip, tickets or any other manner whatsoever.
This permit is not valid on liquorJicensed premises while the liquor license is suspended.
All liquor served will be purchased in Washington State from an authorized liquor retailer.
This permit will be conspicuously posted in the banquet area.
Liquor will be served and consumed only in the portion of the Building or Location described.
Liquor will be served only to members and invited guests who are 21 years of age or older.
Legal hours for service and consumption of liquor are 6:00 a.m to 2:00 a.m daily
The event and the premises for which the permit is issued will be subject to inspection by any liquor control officer or law enforcement
officer.
ng: WAC 314-18-070 states that no banquet permittee or employee of a banquet permiftee may knowingly permit,
The service of liquor to or consumption of liquor by any person under 21 years of age at the Banquet Permit event.
Any disorderly conduct to occur at the Banquet Permit event.
The service of liquor to or consumption of liquor by an apparently intoxicated person(s).
By making this application and accepting the Banquet Permit YOU ARE ASSUMING FULL RESPONSIBILTY FOR THIS FUNCTION.A
could ubject the violator to criminal prosecution immediate cancel lation of the permit a nd render the application/premises
ineligible for future permits.
permit is not valid unless signed, dated and posted at the event location.
I am assuming full responsibility for the event and the compliance of the -zy**"
Sign your name to affirm the above conditions:3-l'a7Date
LIQ 158 4112
2422 CASCADE CHALLENGE
-
0TH-12TH 3900 pAsco RD cLE ELUM,wAJUNE 1
FRIDAY: PRELIM- I$CI BIRO / $U.PER SPORT- 75 BIRD
$ATURDAY/ $UN,,flAY: MAIN- 400 BIRD
*"$13,725 t,l{ CA$H pRtZES BASED gU 125 ENTRANTS**
cLA$S-$5$0
FRrLW; HOA-$500' RU-$300' 1tt t,N CLASS-9100
$uH,:FR SHORT: HOA-$300/ RU-$15S1 l tt lf*t CLASS- $75
DOOR pRtZES- Mf,RCfi & Ailt|HtO p,RACT|CE- 20 Bt,RDSl$l0
**LIT/IITED GOLF CART$. MUST REGISTER ON LINE*N
BREAKFAST & LU,NCH BY: REGISTER Now ScoREcHAsER.ccM
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CLff HLUM, ilTASHTI\IGT(}N
MINERS
CATERING & EVENTS
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Kittitas County Ofrce Of The Treasurer
Amy Criske, Treasurer
205 W sik Arr{lnu" Suth lU2
Elcruburg, We 98926
Phnne {509) 962-7535 Far (509) 933-8212
Cash Receipts
Receipt Number:
Received From:
FundCode
001
2022-1386
MANDY BUCHHOLZ. ADMIN SUPERVIOSR
Date:03/1412022
Check Amount: 5200.00
Cash Amount: S0.00
Other Arnount: $0.00
Total Amount: 5200.00
Deputy: ELIG Rcceipt Type: CHK
Template:
Comments:
csR2022-1097
SPECIAL EVENT APPLICATION FEE FROM RICH HOYT TO HOST THE CASCADE CHALLENGE
GlCode
1632t7 I
Descriotion
SPECIAL EVENTS FEE
Amount
$200.00
$200.00Total Amount:
Kittitas County Treasurer's Office
Submitted By: ELIZABETH CONZALEZ
(c) 2002 Cashtax All Rights Reserved 031 1 4 12022 1 2:25:39 ELlc