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Certification for Commercial Shooting Facility Operating Permit Application
Jefferson County Sportsmen’s Association (JCSA)
112 Gun Club Road
Port Townsend, WA 98368
File No. OTH19-00016
CERTIFICATION
With regards to the permit application referenced above, in accordance with Jefferson County Code, Ordinance No. 12-1102-18, Section 8.50.240, (8)(b), the Jefferson County Sportsmen’s
Association (UBI #602098603, “JCSA”) as the operator of the existing commercial shooting facility located at 112 Gun Club Road, Port Townsend, WA 98368, by and through its Executive
Board, hereby certifies that the commercial shooting facility:
Is not aware of any requirement for an improvement plan as a condition of the issuance of the operating permit;
Areas of non-compliance at the commercial shooting facility will not increase over time;
That as much as possible the facility meets commonly accepted shooting facility safety and design practices; and,
That the facility shall be operated in a manner that protects the safety of all persons present at the commercial shooting facility and persons on neighboring properties.
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
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Executive Committee Member 1 Date
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Executive Committee Member 2 Date
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Executive Committee Member 3 Date
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Executive Committee Member 4 Date
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Executive Committee Member 5 Date
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Executive Committee Member 6 Date
Notary or agent
State of _______________________________ County of ___________________________________
Signed or attested before me on ___________ by_______________________________________
Print name of person signing this certification
(Seal or stamp) X_________________________________________
Signature of Notary/Agent
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Print or stamp name of Notary/Agent
______________________________________ and ____________________________________ Notary/Agent title Notary expiration date