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BLD2014-00181
• BUILDING PERMIT APPLI•ION BLD14-00181 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00181 Received Date: 5/21/2014 SITE ADDRESS: 902 NESS CORNER RD PORT HADLOCK, 98339 OWNER: SCOTT L BROWNING TRSTE PHONE: 360-379-9428 LORI A BROWNING TRUSTEE 230 RIDGEVIEW DR PORT TOWNSEND WA 98368-2512 CHARAWELL SHORT PLAT SUBDIVISION: Block: Lot: 3 PARCEL NUMBER: 901024112 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: JEANNETTE HUNDLEY PHONE: 360-301-9065 713 PARKRIDGE DR PORT TOWNSEND WA 98368 PROJECT DESCRIPTIOI TEMP. FIREWORK STAND-4TH OF JULY FIREWORKS SALES- NO MLA REQ'D TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP TMP MAIN: INDUSTRIAL: VALUATION CODE EDITION: 2012 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: SHORELINE: CONST TYPE: DECKLE SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $152.00 MEB 05/21/14 148686 Total: $152.00 APPROVED MAY 21 2014 Jefferson County DCD Iblrc.morLlrlafolfnrma\f= RI fl Ann RI.9 mt 6/99 l)fNA mss°o � c � ov �EI 1, - 1 I �w' JEFFERSON COUNTII i ;s L�� i� �k • 5R� �,��, DEPARTMENT OF COMM R1( N DEVELOP_MENT• '.4 621 Sheridan Street • Port v�<sen q tt, - c�,!•A�,�aihi}Ight :83:'.' !'� ,4y 360/379-4450 • 360/379-4 51 ':x 13 ,q O www.co.jefferson.wa.us/co _ elo•me ' st� JEFFERSON COUNTY Master Permit Application OPT.OF COMMUNITY DFVFLOPMENT MLA: _ Project Description(include separ(a^te sheets as necessary.): Tax Parcel Number Q/O2*/2 Property Size: J, 2,6 (acres/ quare feet) Site Address and/or Directions to Property: 902 /U/-ss e,e)e-4 &t 7 Radk, f rt/ft 5833 S Property Owner(s)of Record: 5C d (02-t 62,2xW n t,n p' Telephone:.3(0O 36/- 9/6,-3 Fax: email: .oe/'_ci.hf Mailing Address: LO 2) RAJA.V t-,.,,) D- Q T (,,, A- % Applicant/Agent(if different from owner): ....\ -e.(-{4 W�nd1 Telephone: 3(¢0 301- "In( Fax: email:30111und j.u?( file,&MI Mailing Address:_ -J 13 4:31 t Atfa( Q� P L j g i p' at kind of Permit?(Check each box that applies ❑Lot or Road Segregation Building ❑Critical Areas Stewardship Plan Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home .❑ Modular - ❑ Discretionary"D"or Unnamed Use Classification 0 Commercial ❑Special Use(Essential Public Facilities)** 0 Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat** ❑Home Business ❑Cottage Industry ❑Binding Site Plan** ❑Propane ❑Long Plat** ❑Sign • ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Aavarise Determination(SPAAD)* ❑ Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment O Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: \ DESIGNATION OF AGENT I hereby designate J.0,5-,--4-,u>�.�- u n J- to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 0 R OF Date: 5 ( 2-0\2-04 I By signing this application form,the owner/agent attests that the information provided herein,and in any attachments, is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants pri.r -otice. Signature: �! Ito Date: 517�//`f The action or actions Applicanr will undertake as a resu of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential lake"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsi ility for adherin t and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: /L(j//f BUILDER STATEMENT I I The signer of tnis statement does hereoy certify that they are the Owners of the parcel*e!erenced herein,that they are not licensed contractors and that they will be assuming the responsibiity of the GEnera Contractor for the proposed project Signature: N \ (rye Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALL ER: P:KNEE: FAX: ( ) ( ) MAILING ADDRESS: t wit: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL • Project Type: Frame Type: ' Bathrooms: I Shoreline: j Type of Sewage Disposal: New i : Wood Existing: : Sewer Addition 7 Steel Proposed: Bank 0 Community System Alteration/Remodel 2 Concrete Total: _ I Height: ' Individual System 0 Repair J Masonry 1 -- I SEP Permit# - Demolition 2 Other: Bedrooms: Water Supply: Existing: - Setback: 0 Private well C Two Party Type of Heat: Proposed: I Public Total: I Name of System: • If this is a Commercial Project you must answer the following: N �7� Number of Parking Spaces: Current: Proposed: dE/Numb of ADA Parking Spac s: Number of occupants(includes owners,tenants,employees,etc) Current Proposed • IBC Occupancy: IBC Type of construction: Will you ave Food Service? Yes I No • If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: A/ / i Underground Tank 1 Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove i Woodstove I Fireplace Insert i Hot Water Tank I Pellet Stove I Other Is this appliance being installed in a Manufactured!Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. • • Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bid App Review: 2"3 Floor Heated N K Consistency Review: Other Heated Base fee: 6- Mezzanine Additional Section: Cl I !� Heated Basement Plan Check fee: ", Unheated Basement I State Surcharge fee: Other Unheated Pot Water Review fee: I Garage/Carport SUBTOTAL I I Decks 911/Rd Approach fee: Other I TOTAL: Receipt Number: I ('(gW6 Cash/Check Number: {��—rj3 ESTIMATED COST(REQUIRED) Date: � Q •Fair market value of all labor and materials foundation to finish ] J 2 /L1 Initials: I .J_ _.. ii 846 Ness' Corner Rd, Port IIad'ock-Irondale, WA 98339 U 1.:.. , .. C;(X)!C earth Co sle earth feet 300 A meters 100 xi — ui OZq- I I Z REVIEWED FOR 14 Saki ± L-00_1 Oyu-u3 n\ n Qi 7_.< 3 cylcise■ .st • 1 NOTICE: Plans are approved exceptins 11 any c•cars or omissions. All work must a, c Lc Trr^was i rr7:rtinn M C fnrmvnCs9 with — Se--00,--z-L-3 ali appllicaLle codes am:, re;-?!L,ati ns. JEFFERSON COUNTY DCD BUILDING PLAN REVIEW 0 APPROVED AS SUBMITTED ! Irl 1E C I r4 Q V r 8 APPROVED AS NOTED 0 I r MAY 2 1 2Oi4 ,, ii u 4 L_____ , ❑ REJECTED �, JEFFERSOI�iCOUNTY Date �r SMOReviewer I OPT_OF COMMUNITY DFNFI OPMFNT IT _ _ Map Output Page 1 of 1 • • ArcIMS HTML Viewer Ma • 1 4 `v, 1 `x V. ' +n, k �a a IIIIIIMIOH �a.: a �Al" it a ; 'I cc ( a Legend id4A rry m' d,� Towns A iii.vC?7 r 1.'''.-c-".. a 'S rs;' xY ,,. "' ! �.j.'.� Cau.niy seal a J ty ry Y}tl � g .. � lit- ' * Raul Comws 0, q ,, �' ( t! 21"[- ' °e'�S,Y JC_Roads "" Parcels-H 2011 Aar Photos ' ,V,, - 1 ( H - Ta ep fit". II ^m 41xyJ-cru.skxl tH. !Hex�iCw'P.'v'�tM's,S�s.sz!s GIS .,.. _. FOR INFORMATIONAL PURPOSES ONLY Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Tue Ma 20 15:23:36 2014 . IE: n - ca.. 0 , . i 7----- iJ! ,If_J) 1 MAY 2 1 2014 JEFlERSCN COUNTY i OF COMMUNITY DF1!rLOPMENT .� Lim http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.... 5/20/2014 .. ' <4,V- OG JejjerrorR B.uwtffiy - . 4.'04410;--• w o < Depar-tmeiit of Comnurni(y Derek e,:..," Building Division • 'SH,,,&c° www.co.jefferson.wa.us .Retail Fireworks Stand Inspection Checklist Washington Administrative Code[W.A.C.1:212-17 Stand Address: (its Z- /465.5 Cow, Fa Inspection Date/Time: 74 ® -/:kw i /7 PTFD Permit Number: spector: Felflux I/ALt Permitee Name: 76AMIJ e71 E jutsPL5f A Approved ❑ Reinspection • Retail Stand Requirements /' Maximum size of 400 square feet temporary structure,or tent,or canopy Q' Construction of wood,metal,fiberglass or other similar method only(tents,canopies etc.must meet Uniform Fire Code for fire resistance or treatment) Two exits required-not less than 28 inches wide each i, Interior aisle is to not less than 24 inches from exit door to exit door [ Use of any cloth or fabric requires fire retardant label or treatment i The minimum required area surrounding the stand shall be marked or flagged,except that flagging and marking shall not block a sidewalk or pedestrian way. . Po$fnt;Requirements ' Post State permit Post State Fire Marshal list of approved Class C fireworks ❑ a:-_-- ....-_:: -•• •:.0 J Post"NO SMOKING WITHIN 20 FEET"signs(2 inch letter size min.) [a'/ Post location of nearest working telephone Post emergency 9-1-1 telephone number and site address / Post"NO FIREWORKS DISCHARGE WITHIN 100 FEET"signs(2 inch letter size minimum CY Post"NO SALE OF FIREWORKS TO PERSONS UNDER THE AGE OF SIXTEEN YEARS. PHOTO ID REQUIRED" • Re).iil Stand Setback Requirements Retail stand to be 100 feet from any other stand(s)unless separated by 30 foot wide roadway. Retail stand shall be 20 feet from any other structures(40 Feet from stand front) 5e le Retail stand setbacks 20 feet from public motor vehicle traffic lanes S� - Retail stand front setback 20 feet from private motor vehicle traffic lanes,with 5 foot setback for sides and rear l Retail stand shall be setback 20 feet from front property-lines,and 5 feet rear and side setback from property lines Retail stand shall be setback 20 feet from parking lot Retail stand shall be setback 100 feet from any flammable/combustible liquid gas dispensing devices. H rs of Operation&Leeal Fireworks Discharge Time -(7)..Except as limited by local ordinance,fireworks May be sold from 12:00 noon to 11:00 p.m.on June 28 . , - -throug-t 9:00 p.m.on July 5.Fireworks may not be sold between the hours of 11:00 p.m.and 9:00 aim..from Jurie.4 through July 3.Fireworks may not be sold from 12:00 midnight on July 4 through 9:00 a.m.on July - - . R Stand Occupancy Restrictions At least one adult person 18 years of age or older shall be present at all times No person under the age of 16 is allowed within the retail stand during hours of operation Gyrieral Fire Safety Requirements 144/Access to the retail stand shall be maintained /Inventory of Class C fireworks only /Sales site must be maintained free of accumulation of dry grass,debris,etc. W/Any equipment used shall be listed by an approved product listing agency {,A,. Any heating devices shall have sealed type elements only(i.e.,oil filled or water filled radiator type)and shall have /overheating and tip-over protection shutdown., No open-flame devices allowed /Any electric generator shall be placed 20 feet away from the stand �+ (�/ 1 electrical systems shall comply with the State electrical code W [ fi•wo[2]2.5 gallon water-type fire extinguishers shall be on premises—at each exit Q' One[1]five-pound"ABC"rated fire,extinguisher to be on premises if electrical appliance is at retail stand. ,�aii' . .. , SEE ATTACHED WAC 21247 • ` ' WAC 212-17-185: Retailers of fireworks—License and permit. Page 1 of 1 WAC 212-17-185 Retailers of fireworks—License and permit. (1) Persons desiring to engage in the business of selling fireworks at retail shall secure a license from the director of the Washington state patrol fire protection bureau. (2) In addition to the state license, a permit must be obtained from the local governmental officials having jurisdiction. (a) The application shall be made on forms provided by the director of fire protection and shall be accompanied by the license fee of forty dollars. (b) License applications shall be made on or before May 1 of the year for which the license is desired. (c) The director of fire protection shall grant or deny the license within fifteen days of receipt of the application. (d) Applicants are cautioned to first determine whether a local retail sales permit for fireworks can be obtained. (3) A retailer's license to sell fireworks shall not authorize the licensee to engage in any other fireworks activity. Retailers are limited to selling only those fireworks which have been approved for sale to the public and appear on the list of approved fireworks published annually by the director of fire protection. A copy of the list shall be prominently posted at each retail outlet. [Statutory Authority: Chapters 43.43 and 70.77 RCW. WSR 05-12-033, § 212-17-185, filed 5/24/05, effective 6/24/05. Statutory Authority: RCW 70.77.250 and chapters 70.77 and 43.43 RCW. WSR 98- 04-007, § 212-17-185, filed 1/23/98, effective 2/23/98. Statutory Authority: Chapter 70.77 RCW. WSR 88-08-027 (Order FPS 88-01), § 212-17-185, filed 3/31/88. Statutory Authority: RCW 70.77.250. WSR 84-23-009 (Order FM 84-05), § 212-17-185, filed 11/9/84. Statutory Authority: RCW 70.77.250 and chapter 48.48 RCW. WSR 82-22-068 (Order FM 82-10), § 212-17-185, filed 11/2/82.] http://apps.leg.wa.gov/WAC/default.aspx?cite°212-17-185 5/21/2014 WAC 212-17-198: Retailers of fireworks—List. Page 1 of 2 WAC 212-17-198 Retailers of fireworks—List. The following is the list of fireworks that may be sold to the public. (1) Ground and hand-held sparkling devices. (a) Dipped stick, sparkler. Stick, or wire coated with pyrotechnic composition that produces a shower of sparks upon ignition. Total pyrotechnic composition may not exceed 100 grams per item. Those devices containing any perchiorate or chlorate salts may not exceed 5 grams of pyrotechnic composition per item. Wire sparklers which contain no magnesium and which contain less than 100 grams of composition per item, not Class C explosives under DOT regulations, are included in this category. (b) Cylindrical fountain. Cylindrical tubes not more than 3/4 inch (19 mm) inside diameter, containing up to 75 grams of pyrotechnic composition. Upon ignition, a shower of colored sparks, and sometimes a whistling effect is produced. This device may be provided with a spike for insertion into the ground (spike fountain), a wood or plastic base for placing on the ground (base fountain), or a wood or cardboard handle, if intended to be hand-held (handle fountain). (c) Cone fountain. Cardboard or heavy paper cone containing up to 50 grams of pyrotechnic composition. The effect is the same as that of a cylindrical fountain. (d) Illuminating torch. Cylindrical tube containing up to 100 grams of pyrotechnic composition. Upon ignition, colored fire is produced. May be spike, base, or hand-held. (e) Wheel. Pyrotechnic device attached to a post or tree by means of a nail or string. Each wheel may contain up to six "driver" units; tubes not exceeding 1/2 inch (12.5 mm) inside diameter and containing up to 60 grams of pyrotechnic composition. Total pyrotechnic composition of each wheel shall not exceed 240 grams. Upon ignition, the wheel revolves, producing a shower of color and sparks and, sometimes, a whistling effect. (f) Ground spinner. Small device similar to a wheel in design and effect and placed on the ground and ignited. A shower of sparks and color is produced by the rapidly spinning device. (g) Flitter sparkler. Narrow paper tube filled with pyrotechnic composition that produces color and sparks upon ignition. This device does not have a fuse for ignition. The paper at one end of the tube is ignited to make the device function. (2) Aerial devices. (a) Helicopter, aerial spinner. A tube not more than 1/2 inch (12.5 mm) inside diameter and containing up to 20 grams of pyrotechnic composition. A propeller or blade is attached, which, upon ignition, lifts the rapidly spinning device into the air. A visible or audible effect is produced at the height of flight. (b) Roman candles. Heavy paper or cardboard tube not exceeding 3/8 inch (9.5 mm) inside diameter and containing up to 20 grams of pyrotechnic composition. Upon ignition, up to ten "stars" (pellets of pressed pyrotechnic composition that burn with bright color) are individually expelled at several-second intervals. (c) Mine, shell. Heavy cardboard or paper tube up to 2 1/2 inches (63.5 mm) inside diameter attached to a wood or plastic base and containing up to 40 grams of pyrotechnic composition. Upon ignition, "stars," firecrackers, or other devices are propelled into the air. The tube remains on the ground. (d) Aerial shell. A 1 3/4" or smaller cylindrical or spherical cartridge containing up to 40 grams of chemical composition. (e) Mortar. A 1 3/4" or smaller cardboard tube in which aerial shells are discharged into the air. (3) Combination items. Fireworks devices containing combinations of two or more of the effects described in this section. (4) Smoke device. Tube or sphere containing pyrotechnic composition that, upon ignition, produces white or colored smoke as the primary effect. (5) Division 1.4G explosives classified on January 1, 1984 as consumer fireworks by the United States Department of Transportation except that the term shall not include firecrackers, salutes, chasers, skyrockets or missile-type rockets. http://apps.leg.wa.gov/WAC/defaultaspx?cite=212-17-198 5/21/2014 WAC 212-17-198: Retailers of fireworks—List. Page 2 of 2 [Statutory Authority: Chapters 43.43 and 70.77 RCW. WSR 05-12-033, § 212-17-198, filed 5/24/05, effective 6/24/05. Statutory Authority: RCW 70.77.250. WSR 84-23-009 (Order FM 84-05), § 212-17- 198, filed 11/9/84.] http://apps.leg.wa.gov/WAC/default.aspx?cite=212-17-198 5/21/2014 WAC 212-17-203: Retailers of fireworks—List to be posted. Page 1 of 1 WAC 212-17-203 Retailers of fireworks—List to be posted. Retailers shall post prominently at each retail outlet a list of the fireworks that may be sold to the public. The posted list shall be in a form approved by the director of fire protection. The director of fire protection shall make available the list. [Statutory Authority: Chapter 70.77 RCW. WSR 88-08-027 (Order FPS 88-01), § 212-17-203, filed 3/31/88. Statutory Authority: RCW 70.77.250. WSR 84-23-009 (Order FM 84-05), § 212-17-203, filed 11/9/84.] http://apps.leg.wa.gov/WAC/default.aspx?cite=212-17-203 5/21/2014 WAC 212-17-21503: Retailers of fireworks—Definitions. Page 1 of 1 WAC 212-17-21503 Retailers of fireworks—Definitions. (1) "Consumer fireworks" means those fireworks defined as consumer fireworks in RCW 70.77.136. (2) "Following year" means the year immediately following the year in which a license or permit is issued. (3) "License" means a license as defined in RCW 70.77.170. (4) "Magazine" means a structure as defined in Section 3302.1 of the International Fire Code. (5) "Membrane material" means a thin, flexible, impervious material capable of being supported by an air pressure of 1.5 inches of water column (373 Pa). (6) "Permanent retail or wholesale structure" means an enclosure or shelter erected for a period of thirty days or more used for the sales, at retail or wholesale, of legal fireworks of any kind. (7) "Permanent storage structure" means a building or other structure used to store any fireworks not authorized within the scope of a retail fireworks stand permit. (8) "Permit" means a permit as defined in RCW 70.77.180. (9) "Private way" means any privately owned driveway, lane, access way or similar parcel of land essentially unobstructed from the ground to the sky which serves as access from private property to a public road. (10) "Public road" means any street or alley essentially unobstructed from the ground to the sky which is deeded, dedicated or otherwise permanently appropriated to the public for public use. (11) "Recognized testing laboratory" means a nationally recognized testing laboratory approved by the state fire marshal. (12) "Temperature overheat protection" means a device which immediately interrupts the power to the heating element of a portable heating unit when the portable heating unit exceeds its designed operating temperature. (13) "Temporary power drop" means an electrical service connection to a temporary retail fireworks stand. (14) "Retail fireworks stand" means a structure used for the retail sales of consumer fireworks. (15) "Temporary storage structure" means a building or other structure used for storage of consumer fireworks directly related to a retail fireworks stand and authorized within the scope of a retail fireworks stand permit. (16) "Temporary structure" means an enclosure or shelter erected for a period of less than thirty days and not otherwise defined in the International Fire Code as a tent or canopy. (17) "Tip-over protection" means a device which immediately interrupts the power to the heating element of a portable heating unit when the portable heating unit is tipped or tilted more than forty-five degrees from its designed operating position. (18) "International Building Code" means the edition currently adopted by the state of Washington. (19) "International Fire Code" means the edition currently adopted by the state of Washington. [Statutory Authority: Chapters 43.43 and 70.77 RCW. WSR 05-12-033, § 212-17-21503, filed 5/24/05, effective 6/24/05. Statutory Authority: RCW 70.77.250 and chapters 70.77 and 43.43 RCW. WSR 98- 04-007, § 212-17-21503, filed 1/23/98, effective 2/23/98.] Uri U http://apps.leg.wa.gov/WAC/default.aspx?cite=212-17-21503 5/21/2014 WAC 212-17-21505: Retailers of fireworks—General provisions. Page 1 of 1 WAC 212-17-21505 Retailers of fireworks—General provisions. (1) The state of Washington hereby fully occupies the entire field of regulation relating to the construction and use of temporary and permanent structures for the retail sale and storage of fireworks including: The location of and areas surrounding, the operation of and the cleanup after the use of said structures, pursuant to RCW 70.77.270. (2) The state of Washington hereby preempts the authority of local jurisdictions with respect to the retail sale and associated storage of consumer fireworks from temporary structures. This rule constitutes the entire and exclusive authority for regulation of all such matters. Subject to the limitations imposed by chapter 70.77 RCW, a city or county may ban fireworks; or a city or county may restrict the dates of sale, purchase, possession and use of fireworks; or a city or county may restrict the types of fireworks that may be sold and purchased within its boundaries. If a city or county allows the sale of fireworks classified as consumer fireworks from temporary structures these rules preempt that city's or that county's authority to enact or enforce any other regulations. (3) Except as prescribed by this rule, the use of permanent structures or temporary structures over four hundred square feet for fireworks sales and storage shall be subject to the provisions of the International Fire Code and the International Building Code, and local ordinances. (4) The use of temporary structures for the temporary sale or storage of consumer fireworks are exempt from the International Building Code, International Fire Code and local ordinances except that where a city or county ordinance regulates the sale or use of fireworks as a part of that city's or that county's building code or fire code, those provisions of that county's or that city's building code or fire code which are not in conflict with this rule are not hereby preempted or affected. (5) Each license and permit shall be issued and shall remain valid and effective for the thirteen- month period beginning on January 1 of the year in which application is made and ending January 31 of the following year. (6) Only Division 1.4G consumer fireworks, obtained from state-licensed wholesalers, not otherwise prohibited by chapter 70.77 RCW or local ordinance, and holiday related products incidental but related to these products, may be sold in retail fireworks stands. (7) Except as limited by local ordinance, fireworks may be sold from 12:00 noon to 11:00 p.m. on June 28 through 9:00 p.m. on July 5. Fireworks may not be sold between the hours of 11:00 p.m. and 9:00 a.m. from June 28 through July 3. Fireworks may not be sold from 12:00 midnight on July 4 through 9:00 a.m. on July 5. (8) Except as limited by local ordinance, fireworks may be sold from 12:00 noon to 11:00 p.m. on each day from the 27th of December through the 31st of December of each year. (9) Licensees shall familiarize all persons working in a retail fireworks stand with the provisions of these rules. (10) Failure to comply at any time with the provisions of this rule or any other applicable regulation shall constitute a violation of chapter 70.77 RCW and may result in the temporary suspension or immediate revocation of the license or permit, closure of the fireworks sales or storage structure, the seizure and/or forfeiture of some or all of the fireworks, and other criminal penalties as specified by law. (11) The local authority having jurisdiction, with the concurrence of the state fire marshal, is authorized to modify any of the provisions of WAC 212-17-21509, 212-17-21511, 212-17-21513, 212- 17-21515, and 212-17-21517 upon written application by the licensee or a duly authorized representative, where there are practical difficulties in the way of carrying out the provisions of these sections, provided that the spirit of the rule shall be complied with, public safety secured and substantial justice done. The particulars of such modification shall be registered with the state fire marshal. >" [Statutory Authority: Chapters 43.43 and 70.77 RCW. WSR 05-12-033, § 212-17-21505, filed 5/24/05, ���yy effective 6/24/05. Statutory Authority: RCW 70.77.250 and chapters 70.77 and 43.43 ROW. WSR 98- V 04-007, § 212-17-21505, filed 1/23/98, effective 2/23/98.] w J ii http://apps.leg.wa.gov/WAC/default.aspx?cite°212-17-21505 5/21/2014 WAC 212-17-21507: Retailers of fireworks—Transportation. Page 1 of 1 WAC 212-17-21507 Retailers of fireworks—Transportation. When transporting fireworks, licensees shall comply with all federal, state and local transportation requirements, provided that, upon request of the licensee, the local authority having jurisdiction may waive or modify the local transportation requirements. Nothing in these rules shall restrict the right of any person to transport, in a private vehicle, fireworks which have been legally purchased from a retail fireworks licensee. [Statutory Authority: Chapters 43.43 and 70.77 RCW. WSR 05-12-033, § 212-17-21507, filed 5/24/05, effective 6/24/05. Statutory Authority: RCW 70.77.250 and chapters 70.77 and 43.43 RCW, WSR 98- 04-007, § 212-17-21507, filed 1/23/98, effective 2/23/98.] http://apps.leg.wa.gov/WAC/default.aspx?cite=212-17-21507 5/21/2014 WAC 212-17-21509: Retailers of fireworks Location. Page 1 of 1 WAC 212-17-21509 Retailers of fireworks—Location. (1) Activities or uses subject to this rule shall not be limited in location except where such activities or uses are prohibited or controlled by local development regulation, traffic safety or road construction standards. (2) Temporary retail fireworks stands shall not be located more than one hundred fifty feet from a private way, fire department access road, public road, street or highway as measured by an approved route around the exterior of the stand. The minimum requirements for a private way shall be determined by the local authority having jurisdiction, but shall not exceed the requirements of locally adopted street, road and access standards. (3) Any two retail fireworks stands shall be at least one hundred feet apart or shall be separated by a road, street or highway not less than thirty feet in width. (4) Retail fireworks stands shall be located as required by Table 212-17-21509 in this section. The minimum required area surrounding the stand shall be marked or flagged, except that flagging and marking shall not block a sidewalk or pedestrian pathway. Flagging need not exceed twenty feet in any direction. Retail Fireworks Stands-Minimum Clearances Motor Motor Vehicle Vehicle Traffic Traffic PUBLIC PRIVATE Buildings Combustibles Property Line Parking ROAD* WAY BACK OF STAND 20 FT. 20 FT. 5 FT. 20 FT. 20 FT. 5 FT. SIDE OF STAND 20 FT. 20 FT. 5 FT. 20 FT. 20 FT. 5 FT. FRONT OF STAND 40 FT. 40 FT. 20 FT. 20 FT. 20 FT. 20 FT. 20 FT.** 20 FT.** NOTE'. Clearance distances are not cumulative * Measured from the outer edge of the nearest traffic lane. ** If stand is equipped with 135 fusible links which will automatically close all sales doors in case of fire,or is equipped with a wire-mesh screen with openings of not more than one inch which covers not less than 90%of all sales openings. (5) Retail fireworks stands shall not be located closer than one hundred feet from any motor vehicle dispensing station, retail propane dispensing station, flammable liquid storage, or combustible liquid storage. Retail fireworks stands shall not be located closer than three hundred feet from any bulk storage of flammable or combustible liquid or gas, including bulk plant dispensing areas. EXCEPTION: 1.Fuel for generators as allowed by WAC 212-17-21513(4). 2.Fuel within the tanks of motor vehicles. [Statutory Authority: Chapters 43.43 and 70.77 RCW. WSR 05-12-033, § 212-17-21509, filed 5/24/05, effective 6/24/05. Statutory Authority: RCW 70.77.250 and chapters 70.77 and 43.43 RCW. WSR 98-04- 007, § 212-17-21509, filed 1/23/98, effective 2/23/98.] http://apps.leg.wa.gov/WAC/default.aspx?c ite=212-17-21509 5/21/2014 WAC 212-17-21511: Retailers of fireworks—Area around the retail fireworks stand. Page 1 of 1 WAC 212-17-21511 Retailers of fireworks—Area around the retail fireworks stand. (1) The minimum areas around the retail fireworks stand specified in WAC 212-17-21509 shall be kept free of accumulation of dry grass, dry brush and combustible debris. No parking shall be permitted within this minimum area. (2) No motor vehicle or trailer may be parked within twenty feet of a retail fireworks stand except when delivering, loading or unloading fireworks. (3) Fireworks shall not be discharged within one hundred feet of a retail fireworks stand. Signs reading "NO FIREWORKS DISCHARGE WITHIN 100 FEET" in letters at least two inches high, with a principal stroke of not less than one-half inch, on contrasting background, shall be conspicuously posted on all four sides of the stand. (4) No smoking shall be allowed within the retail fireworks stand or within the minimum flagged off area. Signs reading "NO SMOKING WITHIN 20 FEET" in letters at least two inches high, with principal stroke of not less than one-half inch, on a contrasting background, shall be conspicuously posted on all four sides of the stand. [Statutory Authority: Chapters 43.43 and 70.77 RCW. WSR 05-12-033, § 212-17-21511, filed 5/24/05, effective 6/24/05. Statutory Authority: RCW 70.77.250 and chapters 70.77 and 43.43 RCW. WSR 98- 04-007, § 212-17-21511, filed 1/23/98, effective 2/23/98.] http://apps.leg.wa.gov/WAC/default.aspx?cite=212-17-21511 5/21/2014 WAC 212-17-21513: Retailers of fireworks Stand use and construction. Page 1 of 1 WAC 212-17-21513 Retailers of fireworks—Stand use and construction. (1) Fireworks may be sold from: (a) A permanent structure which meets provisions of WAC 212-17-21505(3). (b) Temporary, stable structures made from wood, metal, fiberglass or other material. Any temporary fireworks retail stand greater than four hundred square feet shall meet the requirements of a permanent structure, except tents or canopies as defined in the International Fire Code. (c) Tents, canopies, or structures utilizing temporary membrane material. All tents, canopies or temporary membrane materials structures shall be made from fire retardant material or treated with a fire retardant as identified in the International Fire Code. Any tent, canopy or temporary membrane material structure falling within the scope of the International Fire Code shall comply with those requirements. When those requirements are in conflict with other provisions of these rules, the more restrictive provisions shall apply. (2) Battery powered equipment, electrical equipment and electrical cords which are used in conjunction with a retail fireworks stand or a temporary storage structure or location must be listed by a recognized laboratory and used in accordance with that listing. If electrical power is supplied by an extension cord, the size of the cord, the length of the cord and the amperage and the voltage supplied shall be in compliance with the requirements of the National Electrical Code, current edition. The cord shall be protected as necessary from "drive-over" and other physical damage. No additional permits from a city or county or state official having jurisdiction shall be required for these temporary uses except as specified in subsection (5) of this section. (3) All heating units shall be listed by a recognized testing laboratory and shall be used in accordance with the listing. Heating sources shall have "tip-over" and temperature overheat protection. All heating devices shall have sealed type elements (i.e., oil filled or water filled radiator type). Open flame heating devices are prohibited. (4) Generators which use combustible fuel and which are at least twenty feet from the retail fireworks stand or the temporary fireworks storage structure shall be allowed. Generator fuel shall be limited to not more than five gallons and stored at least twenty feet from all stands. (5) Compliance with the National Electrical Code, current edition, shall be required for all new, permanent electrical installations, including temporary power drops, subject to possible permit fees. (6) Retail sales of fireworks and other products which are holiday related shall be from buildings used for no other purpose. [Statutory Authority: Chapters 43.43 and 70.77 RCW. WSR 05-12-033, § 212-17-21513, filed 5/24/05, effective 6/24/05. Statutory Authority: RCW 70.77.250 and chapters 70.77 and 43.43 RCW. WSR 98- 04-007, § 212-17-21513, filed 1/23/98, effective 2/23/98.] http://apps.leg.wa.gov/WAC/default.aspx?cite°212-17-21513 5/21/2014 WAC 212-17-21515: Retailers of fireworks—Operation of retail fireworks stands. Page 1 of 1 WAC 212-17-21515 Retailers of fireworks—Operation of retail fireworks stands. (1) A clear aisle or walkway not less than twenty-four inches wide shall be maintained inside the full length of the structure. Customers shall only be permitted inside a temporary retail fireworks stand that is greater than four hundred square feet and which meets minimum exit requirements of the International Building Code and International Fire Code, as now or amended hereafter. (2) Each temporary retail fireworks stand must have at least two exits, at least twenty-eight inches in width, located at opposite ends of the structure. Exits must remain unlocked and unobstructed during the hours of operation or when the stand is occupied. (3) Sleeping inside a retail fireworks stand or an associated temporary fireworks storage facility is prohibited. (4) The location of the nearest permanently mounted telephone must be posted inside the retail fireworks stand and persons working in the stand shall be informed of that location. (5) The local emergency telephone number shall be conspicuously posted inside the retail fireworks stand. (6) Each retail fireworks stand shall be equipped with two approved, pressurized two and one-half gallon water-type fire extinguishers. (7) No open flames nor any type of open flame equipment shall be allowed in any retail fireworks stand. (8) Retail fireworks stands shall be secured when unoccupied and not open for business if fireworks are kept in the structure during these times. Retail fireworks stands shall never be locked when occupied. The fireworks may be removed and transferred to a temporary storage structure or location approved as a part of the license and permit. (9) At least one adult person, eighteen years of age or older shall be present at all times in every retail fireworks stand during the hours of sale to the public and shall be responsible for supervision of the retail fireworks stand and its operation. No person, other than customers, under the age of sixteen shall be allowed within a retail fireworks stand when it is open to the public. Fireworks, except for prepackaged assortments, boxes, or similarly packaged containers of more than one item, whether of the same or different kind, must be displayed in a manner which prevents the fireworks from being handled by the public or a customer without the direct intervention of the licensee or his or her representative who shall maintain visual contact. (10) Retail fireworks stands may be required to be inspected by the state fire marshal and/or the local jurisdiction issuing the permit prior to opening for business and other inspections may occur on other days as warranted but there shall be no additional charge for all such inspections. (11) In order to obtain return of a clean-up bond if required by the local authority having jurisdiction as a condition of permit, the cleanup of debris associated with the retail fireworks activity and the removal of all structures authorized by the license and permit shall occur on or before the last day of the storage period specified in these rules. (12) Fireworks retailers shall not knowingly sell fireworks to persons under the age of sixteen. (a) A sign reading "no sale of fireworks to persons under the age of sixteen years. PHOTO ID REQUIRED" in letters at least two inches high, with a principal stroke of not less than one-half inch, on contrasting background, shall be conspicuously posted on the front of each retail fireworks stand. (b) Sellers shall require proof of age by means of display of a driver's license or photo identification card showing date of birth issued by a public or private school, state, federal or foreign government. No other forms of identification shall be accepted. [Statutory Authority: Chapters 43.43 and 70.77 RCW. WSR 05-12-033, § 212-17-21515, filed 5/24/05, effective 6/24/05. Statutory Authority: RCW 70.77.250 and chapters 70.77 and 43.43 RCW. WSR 98- 04-007, § 212-17-21515, filed 1/23/98, effective 2/23/98.] http://apps.leg.wa.gov/WAC/default.aspx?cite=212-17-21515 5/21/2014 ,WAC 212-17-21517: Retailers of fireworks—Temporary fireworks storage associated wit... Page 1 of 1 WAC 212-17-21517 Retailers of fireworks—Temporary fireworks storage associated with the retail fireworks stand operation. (1) Temporary fireworks storage is not permanent fireworks storage. Temporary fireworks storage is defined as storage associated with retail fireworks sales and may only be from June 13 through July 31 and from December 12 through January 10 of the following year. Permanent fireworks storage is associated with retail or wholesale fireworks activities when the period of time of storage is other than, or longer than that specified for temporary storage. Temporary fireworks storage shall be in accordance with this section. Permanent fireworks storage is subject to the International Fire Code and the International Building Code and local ordinances. (2) Delivery of fireworks to a location, or storage of fireworks in a facility, not authorized by the license and permit is prohibited. If the approved storage location is outside the jurisdiction issuing the permit, the authority issuing the permit shall notify the appropriate authorities of the jurisdiction in which the storage is to be located. (3) A temporary fireworks storage facility or a temporary fireworks storage location shall be authorized as a part of a license and permit if it meets the requirements specified herein. (4) No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. (5) Storage of fireworks authorized by a retail license and permit is legal only during the periods specified in this section. (6) Fireworks may be stored: (a) In a locked or secured retail fireworks stand; or (b) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than twenty feet from the retail fireworks stand during hours of retail sales; or (c) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than twenty feet from an inhabited building where the term "inhabited building" is defined as in the International Fire Code; or (d) In a magazine which meets the minimum standards of Type 4 as prescribed by the International Fire Code, and which is not less than ten feet from an inhabited building where the term "inhabited building" is defined as in the International Fire Code; or (e) In a locked or secured metal or wooden garage, shed, barn or other accessory building, or anything similar which is not less than: 20 feet from an inhabited building for storage of fireworks for one or two retail stands; or 30 feet from an inhabited building for storage of fireworks for three or more stands. The term "inhabited building" is defined as in the International Fire Code. (7) The local authority having jurisdiction may reduce the minimum separation requirements of this section provided that safety of life and property is not diminished. (8) No cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. (9) Temporary fireworks storage structures may be inspected prior to use and other inspections may occur on other days as warranted. There shall be no additional charge for all such inspections. [Statutory Authority: Chapters 43.43 and 70.77 RCW. WSR 05-12-033, § 212-17-21517, filed 5/24/05, effective 6/24/05. Statutory Authority: RCW 70.77.250 and chapters 70.77 and 43.43 RCW. WSR 98- 04-007, § 212-17-21517, filed 1/23/98, effective 2/23/98.] http://apps.leg.wa.gov/WAC/default.aspx?cite=212-17-21517 5/21/2014 WAC 212-17-21519: Retailers of fireworks—Cleanup. Page 1 of 1 WAC 212-17-21519 Retailers of fireworks—Cleanup. (1) At the end of the legal selling period, all fireworks must remain in the retail fireworks stand, temporary storage location authorized by the retail permit or another location approved by the local authority having jurisdiction or his or her designee until returned to the suppliers from which they were obtained, or until transferred to an approved location. (2) Cities and counties may require a clean-up bond, not to exceed five hundred dollars, as a condition of the permit, to ensure the removal of all structures and debris from the site. (3) In order to obtain return of a clean-up bond, cleanup of debris associated with the retail fireworks activity and the removal of all temporary structures authorized by the license and permit shall be completed no later than 11:59 p.m., July 15 for the Fourth of July selling period or no later than 11:59 p.m., January 10 for the New Year's selling season. (4) Failure of the licensee to comply with subsection (3) of this section shall constitute forfeiture of the clean-up bond and the licensee shall be liable for any clean-up costs incurred by the city or county which exceed the amount of the bond. [Statutory Authority: Chapters 43.43 and 70.77 RCW. WSR 05-12-033, § 212-17-21519, filed 5/24/05, effective 6/24/05. Statutory Authority: RCW 70.77.250 and chapters 70.77 and 43.43 RCW. WSR 98- 04-007, § 212-17-21519, filed 1/23/98, effective 2/23/98.] http://apps.leg.wa.gov/WAC/default.aspx?cite=212-17-21519 5/21/2014 JEFFERSON_ COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 SHERIDAN ST. PORT TOWNSEND WA98388 PH: 360-379-4450 FIREWORKS STAND PERMIT APPLICATION SITE ADDRESS: 911#/ROAD NAME FERINOS PIZZA OR CARLS BLDG SUPPLY 846 NESS CORNER RD, PORT HADLOCK, WA Zip 9 DIGIT PARCEL ID NUMBER APPLICANT CHIMACUM ACTIVITIES PHONE 360-301-9065 MAILING ADDRESS 713 PARKRIDGE DR PORT TOWNSEND, WA Zip 98368 PROPERTY OWNER AdMJL &w1 , 5 PHONE -4,2 o-3ac-o /o MAILING ADDRESS SAIA4EA-S}OJT ZIP STATE PERMIT# WSPFL- 00585 EXP. DATE 01/31/2015 By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities, judgments, court costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. APPLICANT SIGNATURE 7(fy� vutzA DATE 'fi / /y / 111 - - ( GGG FOR OFFICE USE ONLY BASE FEE 52 . 00 RECEIPT d STATE SURCHARGE 4.50 CASH/CK# TOTAL 56 . 50 DATE / / H.\HOME\PLNCNTR\FORMS\FIRE.DOC10/02 You must submit a Site Plan and Flo•i ' an of the S See attached checkli - MAY 2 1 2014 JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT • • ,, FIRE PROTECTION BUREAU ow '��' FIREWORKS LICENSING PROGRAM PO Box 42600 ,a�, Olympia WA 98504-2600 ' ' •°'� (360)596-3914 FAX: (360)596-3934 E APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWM6 0 0 6 TO Governing body of city,town, or county in which DATE OF 02/2014 fireworks stand will be located. APPLICATION Applicant Name Address,City,State CHIMACUM ACTIVITIES 2120 MILWAUKEE WAY, TACOMA, WA 98421 Sponsor(If other than applicant) Address,City,State JEANETTE HUNDLEY 2120 MILWAUKEE WAY, TACOMA, WA 98421 Location of proposed fireworks stand[Enclose drawing of stand location] FERINOS PIZZA 846 NESS CORNER RD, PORT HADLOCK, WA Manner and place of storage prior,during,and after sales dates ON SITE WITH SECURITY State-Licensed Fireworks Supplier AMERICAN PROMOTIONAL EVENTS NW 2120 MILWAUKEE WAY, TACOMA, WA 98421 FIREWORKS STAND PERMIT For the Fireworks Sales Year of: 2014 (Must be conspicuously displayed at all times while the stand is open to the public) By virtue of having been granted a license by the State of Washington and this permit from JEFFERSON COUNTY as the local governing authority,the named person, firm or organization is hereby authorized to sell U.N. 0336 1.4G Consumer fireworks at the location designated herein between the following date and times: Sales for July 4th Sales for December 31st From: 7 t/ZO/41- From: To: 9/5/2019 To: Sponsor CHTMACOIM ACTTVTTTES Location FERINOS PIZZA 846 NESS CORNER RD, PORT HADLOCK, WA /s/ is/ {Aj6 FOR JEANETTE HUNDLEY Signature of Official Granting Permit Signaturebf Applicant Title Agency ME Permit Number Licensee Name HIMACUM ACTTVTTES License Number 052-3<3 5 MAY 2 1 2014 aoia.ls.33- JE:FERSON COUNTY PrPT OF COMMUNITY CCE'IFLOPMET r �� • • ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE 10/31/DDIYYVY) L..-- l ln,zol4 10/31/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONT PRODUCER Lockton Companies,LLC NAMEACT 3280 Peachtree Road NE,Suite#250 PHONE I FAX US/C.No.Est):_ (A/C,Nol: Atlanta GA 30305 E-MAIL (404)460-3600 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Everest Indemnity Insurance Company 10851 INSURED American Promotional Events,Inc. INSURER B: 1359629 DBA TNT Fireworks,Inc. INSURER C: P.O.Box 1318 INSURER D: 4511 Helton Drive Florence AL 35630 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 12219607 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MM/DD/YYW) (MM/DO/YYYY) LIMITS A GENERAL LIABILITY N N SI8GL00242-131 11/1;2013 11/1/2014 EACH OCCURRENCE $ 1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED l PREMISES(Ea occurrence) $ 300,000 CLAIMS-MADE X(OCCUR MED EXP(Any one person) $ 5.000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2.000.000 POLICY r- PRO JECT .x LOC $ AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMI I (Ea accident) $ XXXXXXX I ANY AUTO BODILY INJURY(Per person) $ XXXXXXX ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX — AUTOS _ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ XXXXXXX AUTOS (Per accidentl $ XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION NOT APPLICABLE WCSIATU- IH- ANDEMPLOYERS'LIABILITY Y/N TORY LIMITS( to ER ANY urn CER/MEMBER EXCLUDED?ECUTIVE NIA E.L.EACH ACCIDENT S XXXXXXX (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ XXXXXXX If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S XXXXXXX DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Femino's Pizza located at 846 Ness Corner Rd in Fort Hadlock,WA(Loc.6006)Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms,conditions,and exclusions. CERTIFICATE HOLDER CANCELLATION ---.-. . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T)) rE � Trf rl I (rte r'�, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN u v l-� ^� ACCORDANCE WITH THE POLICY PROVISIONS� 12219607 10 AUTHORIZED REPRESENTATIVE Chirnicum Activities I MAY 2 1 2014 Ferninos Pizza Jefferson County a j1 621 Sheridan Ave 1 Port Townsend WA 98368 JEFFERSON COUNT � . `)EP I 0 (` ,.9,1 IN'TY DEVr I nPMFNT ', ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD © ORD CORP.-ATION.All rights reserved • _ • rn r C M b n CC) N -. y' $ "cl, a7 opo a a p CD o C. ep i a a t CD eD cn '0 R Cr 17 O' wl m � � et O o q A C �• • VD N t, \ s b o 00 a � rt • A7 cv0 d Mnl + r,5 W CA 11' 27 ET h 0 C S ` d oA - 3' B' 6 C ❑ CZ 2 CD Ind tli m S — e' to O m aa- �. C 8. to o' '.r. m d ,q e 0 ...\-,, 0 0 eD CD rA frill `, N ""+ 0 co \W y N'J c:, C n A p m C. g it Z fr O A y O 'n Z A .f f.' `p •'vi. 3 11 y \. E• y �•t o o C o Cr 00 A 'II A f0 ° o4F ^ s a. C g' 4- r-ro ' A 309 w L 8._°ox7 4)g = o. � 11y o mN.. Ln C '> > .t. ! O i'7,' Et.,: y ° r h fn O rr+ ' C A w � � � et. i°3. a ! 12;*. cA o I / n °� /L1 MA4 iji L_ EIF Rso. COUNTY ?F P?OF CO^.1A4UNITY DEVFI OPMFNT • • Jefferson County Building Division Permit Number: BLD14-00181 Applicant: BROWNING TRSTE BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor & Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks 5/21/2014 to i* Parking 5/21/2014 1y3e�i4 f Miscellaneous 5/21/2014 �/3 //q pl" E7p,L A AYN Miscellaneous 1/302/ ' B,1'/t t Miscellaneous A final inspection will not be scheduled until all of the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • CONDITIONS for Building Permit# :BLD14-00181 1.) BUILDING PERMIT IS NOT FINALEDAND STILL CONSIDERED ACTIVE UNTIL AN INSPECTION HAS BEEN CONDUCTED FOLLOWING BREAKDOWN OF STRUCTURE. PLEASE CALL THE INSPECTION HOTLINE AT 360-379-4455 FOR ALL INSPECTIONS. \\tidemark\data\forms\F_BLD_Permit_BIdg.rpt 5/22/2014 • BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00181 Received Date: 5/21/2014 SITE ADDRESS: 902 NESS CORNER RD Issue Date 5/22/2014 PORT HADLOCK, 98339 Expiration Date 5/22/2015 OWNER: SCOTT L BROWNING TRSTE PHONE: 360-379-9428 LORI A BROWNING TRUSTEE 230 RIDGEVIEW DR PORT TOWNSEND WA 98368-2512 CHARAWELL SHORT PLAT SUBDIVISION: Block: Lot: 3 PARCEL NUMBER: 901024112 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: TEMP. FIREWORK STAND-4TH OF JULY FIREWORKS SALES- NO MLA REQ'D TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP TMP MAIN: INDUSTRIAL: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: Type Amount Paid By: Date: Receipt: BATHROOMS: Permit $152.00 MEB 05/21/14 148686 Exist: Total: $152.00 Prop: Total: NUMBER OF EMPLOYEES: Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY - THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY -SEE ATTATCHED