Loading...
HomeMy WebLinkAbout18513 59th Ave Ne_BLD5896_2026 OPERATING PERMIT APPLICATION Department of Community& Economic Development City of Arlington•18204 59th Ave NF•Arlington,WA 98223•Phone(360)403-3551 Part I Applicant/Buildiln'geI�nformatiion ' lI Applicant's Name: erm IJ 1W _ —�ttmd L, U7� Applicant's Address: 250x C(3 _( -- I—7 013 Contact Person: "mg- ?Obltc� Telephone: jCV3 -&5-& Address of Premises for which Operating Permit is requested: ❑ Same as above Other(speci fy):a( rQ, �-k �$�01 5��` 1q l!� N _ ►��g Tax Parcel ID#: Current Occupancy Class: Part H Type of Operating Permit An Operating Permit is required to conduct any activity or to use any class of building listed below. Please indicate the type(s)of Operating Permit(s)requested by checking each applicable box. (If you require assistance, or would like more information, contact the City of Arlington Building Department at 360-403- 3551.) ❑ Manufacturing, storing or rtndlin)hazardous materials in quantities exceeding those listed in the Fire Code (see Appendix A.) Identify the materials and quantities and describe the manner in which the materials will be manufactured, stored or handled (attach additional sheets if necessary):_ Revised 4/l/08 RECEIVED Page I of 4 MAR 15 2024 Part II (cont'd) ❑ Conducting a hazardous process or activity, including,but not limited to,any commercial or industrial operation which produces combustible dust as a byproduct, fruit and crop ripening, waste handling, spray operations, and high-piled storage(see Appendix B.) Describe the process(es)or activity(ies)to be conducted (attach additional sheets if necessary): Use of pyrotechnic devices in assembly occupancies(see Appendix C.) Describe the devices to be used and type of event(attach additional sheets if necessary):EEE_ d qV'U cdw-"+• ❑ Aboveground Storage Tank(AST) (see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary lank closure ❑ Changes in service ❑ Permanent tank closure Brief description: ❑ Underground Storage Tank (UST)(see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary lank closure ❑ Changes in service ❑ Permanent tank closure Brief description: ❑ Temporary Membrane Structures, including tents and canopies(see Appendix E.) Brief description of structure and use: Cc: Fire Department Page 2 of 4 Part II (cont'd) ❑ Special Event Operating Permit-An Operating Permit is required for any special event that takes place within an occupied building, or an outdoor mass gathering,which is outside the scope of the permitted use(see Appendix F.) Brief description of type of gathering proposed: Part III Premises/Building Information I. Date of last inspection of Premises: 2. Has a Certificate of Occupancy been issued for the premises?❑ Yes❑ No Type: ❑ Permanent❑ Temporary Date of Issuance: 3. Are there currently any open Building Permits associated with the premises? ❑ Yes ❑ No If yes, please describe (attach additional sheets if necessary): 4. Additional Comments: SIGNATURE. OF APPLICANT I herby certify that the foregoing information (and all information in attached sheets, if any) is true and complete. A'A" � , Signature of Applicant or Authorized Representatives Signature Date AA-)tea-- Name and Title (if applicable)of person signing Application (Please print) Cc: Fire Department Page 3 of 4 Part IV To be completed by the City of Arlington Building Department Inspection Required: XYes ❑No Inspections Performed: ❑ Yes E;rNo Date of Inspection: Tests or Reports required verifying compliance? ❑ Yes&No If YES, have Tests or Reports been received? ❑ Yes ❑ No Application(s) Approved: Yes ❑ No Operating Permit Issued by: Date Operating Permit Issued: � "I _ Date Operating Permit Expires: 44�� Type/Description of Operating Permit: Czti 1 -6.0 `_- Conditions of Operating Permit(list conditions here AND in the space provided in the Operating Permit):Additional Comments: (Attach additional pages if needed) Cc: Fire Department Page 4 of 4 ° OPERATING PERMIT APPLICATION _ Department of Community& Economic Development City of Arlington•18204 59th Ave NE•Arlington,WA 98223•Phone(360)403-3551 Part I ApplicantBuildi'n'gnInformatiion Applicant's Name: Applicant's Address: `- D TZx q,3Z CPt1hA-., i—]013 Contact Person: &- h6t/'� Telephone: JcV3 "&5- Jgg9 Address of Premises for which Operating Permit is requested: ❑ Same as above Other (specify): t tgUG N . i�t Y) } q gaaa Tax Parcel ID #: Current Occupancy Class: Part II Type of Operating Permit An Operating Permit is required to conduct any activity or to use any class of building listed below. Please indicate the type(s) of Operating Permit(s) requested by checking each applicable box. (If you require assistance, or would like more information, contact the City of Arlington Building Department at 360-403- 3551.) ❑ Manufacturing, storing or6ldliDhazardous materials in quantities exceeding those listed in the Fire Code (see Appendix A.) Identify the materials and quantities and describe the manner in which the materials will be manufactured, stored or handled (attach additional sheets if necessary): Revised 4/l/08 Page 1 of 4 Part H (cont'd) ❑ Conducting a hazardous process or activity, including, but not limited to, any commercial or industrial operation which produces combustible dust as a byproduct, fruit and crop ripening, waste handling, spray operations, and high-piled storage (see Appendix B.) Describe the process(es) or activity(ies)to be conducted (attach additional sheets if necessary): Use of pyrotechnic devices in assembly occupancies (see Appendix C.) Describe the devices to be used and type of event (attach additional sheets if necessary): SE id LI)e d I CohA4` �fX`► 1-'1 Y'CIJ►9�1(�L ��Sp 1(x,�, — �i2Q(1�'►`e.12.- 4�I,tA.S ❑ Aboveground Storage Tank(AST) (see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary lank closure ❑ Changes in service ❑ Permanent tank closure Brief description: ❑ Underground Storage Tank(UST) (see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary lank closure ❑ Changes in service ❑ Permanent tank closure Brief description: ❑ Temporary Membrane Structures, including tents and canopies (see Appendix E.) Brief description of structure and use: Cc: Fire Department Page 2 of 4 Part II (cont'd) ❑ Special Event Operating Permit -An Operating Permit is required for any special event that takes place within an occupied building, or an outdoor mass gathering,which is outside the scope of the permitted use (see Appendix F.) Brief description of type of gathering proposed: Part III Premises/Building Information Date of last inspection of Premises: 2. Has a Certificate of Occupancy been issued for the premises? ❑ Yes ❑ No Type: ❑ Permanent ❑ Temporary Date of Issuance: 3. Are there currently any open Building Permits associated with the premises? ❑ Yes ❑ No If yes, please describe (attach additional sheets if necessary): 4. Additional Comments: SIGNATURE OF APPLICANT I herby certify that the foregoing information (and all information in attached sheets, if any) is true and complete. Aau"" Signature of Applicant or Authorized Representatives Signature Date �'S Arm--,--Ftx�-- Name and Title (if applicable) of person signing Application (Please print) Cc: Fire Department Page 3 of 4 Part IV To be completed by the City of Arlington Building Department Inspection Required: ❑ Yes ❑No Inspections Performed: ❑ Yes ❑ No Date of Inspection: Tests or Reports required verifying compliance? ❑ Yes ❑No If YES, have Tests or Reports been received? ❑ Yes ❑ No Application(s) Approved: ❑ Yes ❑ No Operating Permit Issued by: Date Operating Permit Issued: Date Operating Permit Expires: Type/Description of Operating Permit: Conditions of Operating Permit(list conditions here AND in the space provided in the Operating Permit): Additional Comments: (Attach additional pages if needed) Cc: Fire Department Page 4 of 4 A CERTIFICATE OF LIABILITY INSURANCE DAr9/26/20 3rr) 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(ies) 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). PRODUCER CONTACT NAME: Acrisure, LLC dba Britton Gallagher&Associates PHONE FAx One Cleveland Center, Floor 30 A/C No Ext: 216-658-7100 A/C No):216-658-7101 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Everest Indemnity Insurance Co. 10851 INSURED 18234 INSURER B:Axis Surplus Ins Company 26620 Western Display Fireworks Ltd. P. O. Box 932 INSURERC:Alaska National Insurance Company Canby OR 97013 INSURERD: Everest Denali Insurance Company 16044 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1265055898 REVISION NUMBER: 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 SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY S18ML00215-231 1/15/2023 1/15/2024 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS Ea occurrence) $500,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X jE LOC1 1 $ D AUTOMOBILE LIABILITY S18CA00098-231 1/15/2023 1/15/2024 COMBINED SINGLE LIMIT Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident B UMBRELLA LIAB X OCCUR P-001-000069176-05 1/15/2023 1/15/2024 EACH OCCURRENCE $4,000,000 X EXCESS LAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ A WORKERS COMPENSATION S18ML00215-231 1/15/2023 1/15/2024 WC STATU- X OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER Stop Gap ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Washington USLH 22D WU 08933(WA) 4/16/2023 4/16/2024 BI by Accident $1,000,000 BI by disease policy limit$1,000,000 BI by disease Each Employees1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Display Date:7/4/24 Display Site:Quake Park, 18501 59th Ave NE,Arlington,WA 98223 Additional Insured: The City of Arlington,it's officers,agents and employees Arlington Fire Dept. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Arlington 238 N Olympic Ave AUTHORIZED REPRESENTATIVE Arlington WA 98223 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Exhibit A- Display Site Map -Arlington Ott cer ' ­41+ _ ir— ..r _s 300' �� - Discharge Site "A; F u ��� Fall Out Area Fall Out Area 20'x10' qlpr ill Quake Memorial Park Fall Out Area 300' Fall Out Area • Spectators Western Display Fireworks LTD. Bill Quake Memorial Park—Arlington,WA I.j Discharge Site 20'x10' ^' 48'9'56.05"N 122'8'58.36"W r` ��µ�HaroHara?�, Washington State Patrol Fire Protection Bureau 11263P Office of the State Fire Marshal Pyrotechnic Operator License Licensee Data Jeshua Gabeleit� WASHINGTC?` r ' Phone Number. (360) 384-8226 9429 Avon Allen Road \ email Addrciss:jgaboloin@hotmail.com Bove, WA 98232 Date of Isstjp: February 22, 2024 License NUn)ber: P-04364 Gate of Expiration: January 31, 2025 State Fire �4carshal^ icensee Sir ature AX-4x•041110'16' Licensee Wall Mount Card Washington State Patrol Fire Protection Bureau 11263P ^\ Office of the State Fire Marshal Pyrotechnic Operator_ License Lj Licensee Data WASHINGTQ" . T � '�'�'► Jeshua Gabelein Phone Number: (360) 384=8226 9429 Avon Allen Road Email Address:jgabelein@hotmail.com Bova, WA 98232 Date of Issue: February 22, 2024 License Number. P-04364 at of Expiration: January 31, 2025 State Fire Marshal Aucens�tureee�Sig�r-e 30OD-420-U43(lone) General Display Employer Portion 1) Cut along dotted lines to release the four license cards. 2) All four license cards are individually legal and valid evidence of licensing. �' 11263P 3) All four cards constitute an entire license for a single operator. 4) The Licensee must sign all four portions of the license 5) ALL four license cards are legal and valid evidence of licensing. License Number: P-04364 6) The Licensee most carry either the wallet(landscape)or the lanyard card(portrait). Washington State Patrol Fire Protection Bureau License Number: P-04364 �, w Pyrotechnic Operator Pyrotechnic Operator License Licensing Type January 31,2025 Washington State Patrol__]1263P 1i11A5 1lquriEg>S` i Fn4Tk-0-. Fire Pfgjepsjonj3Ursau._._._._a J s e�5a ele a e t� January 1,2 2 ^Je6hua Ga etem - �-- Current) aii n I �r .cf�nic Operator Lcense lgnature 3oo���b ofj� Wrshal Llcerigeb signature 3o0-42A r1W(fdfe Marshal �OINGTONSl4fe Washington State Patrol Fire Protection Bureau G23694 Office of the State Fire Marshal General Display Fireworks License rRRJHACbCE L• U Licensee Data Operational Data Western Display Fireworks,ASHINGTON In State Agent: Incorp Services, Inc. Post Office Box 932 Phone Number: (503) 656-1999 Canby, OR 97013 Email Address: heather@westerndisplay.com ; brent( License Number: C-01316 Date of Issue:January 26]2024 Date of Expiration:January 31, 2025 State Fire Marshal Licensee Signature 3000-420-041(10/18) GTONST+tF Washington State Patrol Fire Protection Bureau G23694 Office of the State Fire Marshal 1:7 ral Display Fireworks License �'AErAR3HAL'S Licensee Data ,� Operational Data rS Western Display Fireworks,LT0 HINGTOC�� In State Agent. Incorp Services, Inc. Post Office Box 932 Phone Number: (503) 656-1999 Canby, OR 97013 Email Address: heather@westerndisplay.com ; brent( License Number: C-0131 Date of Issue:January 26, 2024 Date of Expiration:January 31, 2025 State Fire Marshal Licensee Signature 3000-420-041(10/18) 40N1NGTONS�4r� Washington State Patrol Fire Protection Bureau G23694 ' Office of the State Fire Marshal Gen, ral Display Fireworks License ��'NARJHAtb GE�4 Licensee Data INASHINGTON Operational Data P()� Western Display Fireworks, LTD In State Agent: Incorp Services, Inc. Post Office Box 932 Phone Number: (503) 656-1999 Canby, OR 97013 Email Address: heather@westerndisplay.com ; brent( License Number: C-01316 Date of Issue:Jancbary 26, 2024 Date of Expi ration:January 31, 2025 State Fire Marshal Licensee Signature 3000-420-041(10/18) THIS FORM IS INTENDED TO BE USED AS A GENERIC PUBLIC DISPLAY PERMIT FOR THE AUTHORITY HAVING JURISDICTION AND PYROTECHNIC OPERATORS WITHIN THE STATE OF WASHINGTON WASHINGTON STATE PUBLIC FIREWORKS DISPLAY PERMIT Applicant 1 Name of Event Arlington Frontier Days Street Address Quake Park, 18501 59th Ave NE, Arlington, WA 98223 City Arlington County Snohomish Event Date July 4, 2024 Event Time Approx. 10:00 ❑ AM ❑✓ PM Applicant's/Sponsor's Name City of Arlington Phone No. 360-403-3454 Pyrotechnic Operator Jeshua Gabelein License No. P-04364 Experienced Assistant's Name Steve Townsend General Display Company Name Western Display Fireworks Ltd Phone No. 503-656-1999 Attach a separate piece of paper and/or copies of the following documents: • The number of set pieces, shells (specify single or multiple break), and other items. • The manner and place of storage of such fireworks prior to the display. • A diagram of the grounds on which the display is to be held showing the point at which the fireworks are to be discharged; the location of all buildings, highways, and other lines of communication; the lines behind which the audience will be restrained; and the location of all nearby trees, telegraph or telephone lines, or other overhead obstruction. • Documentary proof of procurement of Surety bond or public liability insurance. Local Fire Code Authority Authority Having Jurisdiction Name of Permitting Official Title Phone No. Permit Granted: ❑ Yes ❑ Yes, with Restrictions (see "Notations" below) ❑ No Restrictions/Notations Signature of Permitting Official Date of Approval Permit Number If approved, this permit is granted for the date and time noted herein under the authority of the International Fire Code in accordance with Revised Code of Washington 70.77 and all applicable rules and ordinances pertaining to fireworks in this jurisdiction. This permit is INVALID unless in the possession of a properly licensed Pyrotechnic Operator, who is responsible for any and all activities associated with the firing of this show. MUST BE APPROVED BY THE AUTHORITY HAVING JURISDICTION 3000-420-050(R 3113) SHOW SHELL COUNT SPONSOR Arlington, City of SHOW#7405 SHOW NAME Frontier Days SHOW DATE Thu,July 4, 2024 TYPE OF SITE LAND SHELLS 2.5" SHELLS 6" SHELLS 283 3" SHELLS 8" SHELLS 4" SHELLS 10" SHELLS 5" SHELLS CAKES, BOXES, CANDLES, SINGLE SHOT, & MODULAR ITEMS 1.75" AND SMALLER CAKES 3 2.5" BOXES 6 1.75" AND SMALLER ZIP/ FAN CAKES 2.5" FANNED BOXES 2 2" BOXES 3" BOXES 2" FANNED BOXES 3" FANNED BOXES 1.2" AND SMALLER MODULAR ITEMS 2" MODULAR ITEMS CANDLES 2.5" MODULAR ITEMS SINGLE SHOT SET PIECES, CLOSE PROXIMATE ADDITIONAL PRODUCT NOTE 1 SET PIECES ADDITIONAL PRODUCT NOTE 2 CLOSE PROXIMATE NOTES 12/12/2023 9/26/23 vas Permit#: 5896 Permit Date: 03/15/24 Permit Type: OPERATING Project Name: Arlington Frontier Days Fireworks Display Applicant Name: Western Display Fireworks Applicant Address: PO BOx 932 Applicant, City, State, Zip: Canby, OR, 97013 Contact: Andrea Robitsch Phone: 503-656-1999 Email: devin@westemdisplay.com Scope of Work: aerial firework display Valuation: 0.00 Square Feet: 0 Number of Stories: 0 Construction Type: Occupancy Group: Ppp�ONJ%lo ID Code: 50000�to Permit Issued: �,� Permit Expires: Form Permit Type: OPERATING Status: IN PROCESS Assigned To: Hannah Hardwick Property Parcel# Address Legal Description Owner Name Owner Phone Zoning 31052200103100 18513 59TH AVE NE SEC 22 TWP 31 RGE ARLINGTON CITY 940 OPEN 05W1/2NW1/4NE1/4 OF SPACE/PARKS Plan Reviews Date Review Type Description Assigned To Review Status 03/15/2024 OPERATING BUILDING In Review 03/15/2024 OPERATING FIRE In Review Fees Fee Description Notes Amount Processing/Technology $25.00 Inspection Operating Permit Inspection $150.00 Total $175.00 Uploaded Files Date File Name 03/15/2024 18953856-20240315 BLD5896 WSP permit application&Shell Count-Arlington 2024.pdf 03/15/2024 18953858-20240315 BLD5896 App,pdf 03/15/2024 18953859-20240315 BLD5896 COI-Arlington 2 24.pdf 03/15/2024 18953860-20240315 BLD5896 Display Sitc iViap.pdf 03/15/2024 18953861-20240315 BLD5896 Pyrotechnic Operator License.pdf 03/15/2024 18953862-20240315 BLD5896 WA General Display License 2024.pdf Permit#: 5896 Permit Date: 03/15/24 Permit Type: OPERATING Project Name: Arlington Frontier Days Fireworks Display Applicant Name: Western Display Fireworks Applicant Address: PO BOx 932 Applicant, City, State, Zip: Canby, OR, 97013 Contact: Andrea Robitsch Phone: 503-656-1999 Email: devin@westerndisplay.com Scope of Work: aerial firework display Valuation: 0.00 Square Feet: 0 Number of Stories: 0 Construction Type: Occupancy Group: ID Code: Permit Issued: 05/01/2024 Permit Expires: 07/05/2024 Form Permit Type: OPERATING Status: COMPLETE Assigned To: Hannah Hardwick Property Parcel# Address Legal Description Owner Name Owner Phone Zoning 31052200103100 18513 59TH AVE NE SEC 22 TWP 31 RGE ARLINGTON CITY 940 OPEN 05W1/2 NW1/4 NE1/4 OF SPACE/PARKS Plan Reviews Date Review Type Description Assigned To Review Status 03/15/2024 OPERATING BUILDING No Comment Received 03/15/2024 OPERATING Fireworks review and inspection day of FIRE Approved with Conditions Fees Fee Description Notes Amount Processing/Technology $25.00 Inspection Operating Permit Inspection $150.00 Credit Card Service $5.25 Total $180.25 Payments Date Paid By Description Payment Type Accepted By Amount 04/16/2024 XBP Con£ $175.00 170510000 04/16/2024 Kimberly Dodgion 170510000 $5.25 Outstanding Balance $0.00 Uploaded Files Date File Name 05/01/2024 20340820-2024 BLD5896 IssuedPermit.pdf 04/16/2024 20081810-20240416 BLD5896 Fire Anproval.pdf 03/15/2024 18953856-20240315 BLD5896 WSP permit application&Shell Count-Arlington 2024.pdf 03/15/2024 18953858-20240315 BLD5896 App.pdf 03/15/2024 18953859-20240315 BLD5896 COI-Arlington 2024.pdf 03/15/2024 18953860-20240315 BLD5896 Display Site Map.pdf 03/15/2024 18953861-20240315 BLD5896 Pyrotechnic Operator License.pdf 03/15/2024 18953862-20240315 BLD5896 WA General Display License 2024.pdf Date: 05/18/2026 Permit#: 5896 Permit Date: 03/15/2024 Review Date: 03/15/2024 Permit Type: OPERATING Review Type: OPERATING Target Date: 04/12/2024 Scheduled Time: 07:00 Completed Date: 04/12/2024 Description: Fireworks review and inspection day of Review Status: Approved with Conditions Assigned To: FIRE Time In: 07:00 Time Out: 10:00 Hours: 3.0 Property Information Parcel#: 31052200103100 ARLINGTON CITY OF ARLINGTON CITY OF 18204 59TH DRIVE NE 18513 59TH AVE NE ARLINGTON, WA 98223 Zoning: 940 OPEN SPACE/PARKSLot: 42 & 43Block: GOVERNMENT PROPERTY Permit#: 5896 Permit Date: 03/15/24 Permit Type: OPERATING Project Name: Arlington Frontier Days Fireworks Display Applicant Name: Western Display Fireworks Applicant Address: PO BOx 932 Applicant, City, State, Zip: Canby, OR, 97013 Contact: Andrea Robitsch Phone: 503-656-1999 Email: devin@westerndisplay.com Scope of Work: aerial firework display Valuation: 0.00 Square Feet: 0 Number of Stories: 0 Construction Type: Occupancy Group: ID Code: Permit Issued: 05/01/2024 Permit Expires: 07/05/2024 Form Permit Type: OPERATING Status: COMPLETE Assigned To: Hannah Hardwick Property Parcel# Address Legal Description Owner Name Owner Phone Zoning 31052200103100 18513 59TH AVE NE SEC 22 TWP 31 RGE ARLINGTON CITY 940 OPEN 05W1/2 NW1/4 NE1/4 OF SPACE/PARKS Plan Reviews Date Review Type Description Assigned To Review Status 03/15/2024 OPERATING BUILDING No Comment Received 03/15/2024 OPERATING Fireworks review and inspection day of FIRE Approved with Conditions Fees Fee Description Notes Amount Processing/Technology $25.00 Inspection Operating Permit Inspection $150.00 Credit Card Service $5.25 Total $180.25 Payments Date Paid By Description Payment Type Accepted By Amount 04/16/2024 XBP Con£ $175.00 170510000 04/16/2024 Kimberly Dodgion 170510000 $5.25 Outstanding Balance $0.00 Uploaded Files Date File Name 05/01/2024 20340820-2024 BLD5896 IssuedPermit.pdf 04/16/2024 20081810-20240416 BLD5896 Fire Anproval.pdf 03/15/2024 18953856-20240315 BLD5896 WSP permit application&Shell Count-Arlington 2024.pdf 03/15/2024 18953858-20240315 BLD5896 App.pdf 03/15/2024 18953859-20240315 BLD5896 COI-Arlington 2024.pdf 03/15/2024 18953860-20240315 BLD5896 Display Site Map.pdf 03/15/2024 18953861-20240315 BLD5896 Pyrotechnic Operator License.pdf 03/15/2024 18953862-20240315 BLD5896 WA General Display License 2024.pdf