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HomeMy WebLinkAbout18513 59TH AVE NE_P26-0301_2026 OPERATING PERMIT APPLICATION Department of Community& Economic Development City or Arlington• 18204 59th Ave NI:•Arlington,WA 98223• Phone(360)403-3551 Part I Applicant/Building Information Applicant's Name: �&&.0 cxn "DI-SaI&_���Y tw9 (-S .o � 4d. Applicant's Address: PO Box 9'3 2, Ca n b(� �(Z —�- 70(3 � Contact Person: Veev POo rr4I Telephone: Sos-�s�' 19Q9 Address of Premises for which Operating Permit is requested: ❑ Same as above ® Other(specily): Qttalt[ l?atk /$S`nr 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 or candling 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): See e G.4ACW ro 4 i I Cal tt1.� Revised 4/l/08 Page I 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): FX 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): a�� (( n f- ❑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 1. Date of last inspection of Premises: 2. I las 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 1 herby certify that the foregoing information (and all information in attached sheets, if any) is true and complete. Signature of Applicant or Authorized Representatives Signature Date Davin ?&P yrrn-r+ ��I� Name and Title (il 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 ❑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: ,�T Yes ❑ No Operating Permit Issued by: Date Operating Permit Issued: Date Operating Permit Expires: j��� Type/Description of Operating Permit: 1 QrL Conditions of Operating Permit(list conditions here AND in the space provided in theJperating Permit): ay C _ _ -� 1 *0y Additional Comments: (Attach additional pages if needed) Cc: Fire Department Page 4 of 4 Exhibit A—Display Site Map—Arlington i - 300' r `, Fall Out Area Fall Out Area r ♦ r 1 330 350' r r y � 1 r a Discharge Site EF r r .� 20'x10' Fall Out Area Fall Out Area r� .•�'` 1 1 310' o , Western Display Fireworks LTD. Bill Quake Memorial Park—Arlington,WA 1- - - Discharge Site 20'x10' 48'9'56.05"N 122'8'58.36"W Spectators UPDATED 10/16/2024 � 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 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, 2026 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 North County Regional Fire Authority Name of Permitting Official Steve Goforth Title Assistant Chief- Community Risk Reduction Phone No. 360-502-6184 Permit Granted: [2 Yes M Yes, with Restrictions (see "Notations" below) ❑ No Restrictions/Notations Sustained „r„drs at 7F rnph or ever will he cal to cancel the crcrJrcrrrrccr-w�rrcr� at ���p�� v display at the discretion of the NCRFA Fire Code Official All combustible areas will e wet down prior to the display an a mini imi im of 7 narcnnnel will be On fort.- watch during and after r the display for a period of 1 hour minimm Steve Goforthm 5/7/26 20260704 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 3/13) SHOW SHELL COUNT SPONSOR Arlington, City of SHOW#7896 SHOW NAME Frontier Days SHOW DATE Sat,July 4, 2026 TYPE OF SITE LAND SHELLS 2.5" SHELLS 6" SHELLS 326 3" SHELLS 8" SHELLS 4" SHELLS 10" SHELLS 5" SHELLS CAKES, BOXES, CANDLES, SINGLE SHOT, & MODULAR ITEMS 1.75" AND SMALLER CAKES 5 2.5" BOXES 5 1.75" AND SMALLER ZIP/ FAN CAKES 2.5" FANNED BOXES 2" BOXES 3 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 4/17/2026 10/1305 4rtk( tot( WASHINGTON Permit Information - - , 1 'nformat;^ Permit# 26-0301 Parcel # 31052200103100 Building ID Location 18513 59TH AVE NE Permit Type General Permit Use Operating Zone Permit # Subdivision Applicant Name Western Display Fireworks Address PO Box 932, Canby, Or, 97013 Applicant Email devin@westerndisplay.co Phone 5036561999 Cell m Owner Name ARLINGTON CITY OF Address 18204 59TH DRIVE NE ARLINGTON, WA, 98223 Owner Email arlington@becsc.org Phone Cell Contractor Address Contractor Email Phone Cell Pr—--, 1-f - ation Type/Improveme Accessory/Struct nt ure Current Use A-3 Assembly Proposed Use Current Zoning 0 Proposed Zoning Project Cost Project Value Current Use And Uploaded to Laserfiche- Fireworks display for city 4th of July event Proposed Changes Lot Width Lot Depth Map Number Total Area of Building &Accessory Total Area of All Man-made Improvements Structures (Sq Ft) (Sq Ft) General Notes Restrictions/ Variances ©Community Development Online Portal Page 1 of 4 July 15, 2026 12:44PM WASHINGTON Structure Information Structure Type # of Stories Usable Floor Area (Sq Ft) Structure Height null # of Units 0 Load per Floor (Lbs) Sign Dimensions # of Bedrooms null # of Bathrooms null Occupancy With Chairs Tables & Chairs Empty Room Foundation Foundation Type Footing Depth null Material Foundation Information Setbacks Front& 0 0 Setbacks Right & 0 0 Rear Left Sides Setbacks Information Water Utility Public Sewage Utility Public Gas Utility Public Electric Utility Public Driveway Width null # of Off Street null # of Off Street null Parking Loading Miscellaneous Information ©Community Development Online Portal Page 2 of 4 July 15, 2026 12:44PM 4rtk( tot( WASHINGTON Contacts Contact Name Type Project Address Phone ARLINGTON CITY OF Owner 18204 59TH DRIVE NE ARLINGTON, WA, 98223 Western Display Fireworks Applicant PO Box 932, Canby, Or, 503-656-1999 97013 Arlington Boys& Girls Occupant 18513 59TH AVE NE, Club Arlington WA 98223 ©Community Development Online Portal Page 3 of 4 July 15, 2026 12:44PM 4rtk( tot( WASHINGTON Fees Fee Type Date Debit Credit Balance Permit Fees April 17, 2026 $175.00 $175.00 $175.00 $0.00 T O T A L $175.00 $175.00 $0.00 ©Community Development Online Portal Page 4 of 4 July 15, 2026 12:44PM City of Arlington 14 (11 (0/1 18204 59th Avenue NE, Arlington, • • Washington 98223 Phone: 360-403-3551 jNG� WASHINGTON C Invoice Number: 26-0565 INVOICE Invoice Date:June 1, 2026 Account Number: 3421278816 Bill To: Invoice Questions? Western Display Fireworks Phone: 360-403-3551 PO Box 932 Canby, Or, 97013 Email: ced@arlingtonwa.gov Invoice Due Date:June 1, 2026 Record Number: Permit A26-0301 Parcel Number: 31052200103100 Location: 18513 59TH AVE NE Date Description Paid Date Amount Paid Balance April 17, 2026 Processingfrechnology(320.341.43.00.02) $25.00 April 17, 2026 Inspection(006.322.10.00.01) $150.00 TOTAL: Permit Fees $175.00 $175.00 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- REMITTANCE INFORMATION If you are paying by check, please include this portion with your payment and remit to the address listed on this invoice. Remittance Information Invoice Account Total Due Your payment is due by June 1, 2026 Number Numb This Number Invoice 26-0565 13421278816 $175.00 Western Display Fireworks PO Box 932 Canby, Or, 97013 WASHINGTON Permit #26-0301 Location:18513 59TH AVE NE Routing Details ✓ Department: Permit Tech Intake Review - Approved: April 17, 2026 - Status: Approved Permit Application #A26-0301 Location:18513 59TH AVE NE- by Admin - Hannah Hardwick- Fire Permit Technician II at April 17, 2026 11:50AM Status: Approved Activity Type: In Review Application is ready for review. Admin - Hannah Hardwick City of Arlington Fire Permit Technician II hhardwick@arlingtonwa.gov 360-403-3549 ✓ Department: Permit Tech Final Approval - Approved: July 15, 2026 - Status: Closed Permit Application #A26-0301 Location:18513 59TH AVE NE- by Admin - Hannah Hardwick- Fire Permit Technician II at June 1, 2026 03:53PM Status: Pending Activity Type: Pending Payment Hello, Your invoice is now ready for payment.You can access and process the payment through our portal. Please visit the following link to view and pay your invoice: https://www.civicgov4.com/wa_arlington/portal/index.php?r=site/dashboard Please let me know once you have made payment and I'll provide a copy of your issued permit and approved documents. Admin - Hannah Hardwick City of Arlington Fire Permit Technician II hhardwick@arlingtonwa.gov 360-403-3549 Permit Application #A26-0301 Location:18513 59TH AVE NE- by Admin - Hannah Hardwick- Fire Permit Technician II at June 5, 2026 11:09AM Status: Approved Activity Type: Application Sent Admin - Hannah Hardwick City of Arlington ©Community Development Online Portal Page 1 of 4 July 15, 2026 12:45PM 4rtk( tot( WASHINGTON Fire Permit Technician II hhardwick@arlingtonwa.gov 360-403-3549 Permit #26-0301 Location:18513 59TH AVE NE- by Admin - Hannah Hardwick- Fire Permit Technician II at June 5, 2026 11:09AM Status: Approved Activity Type: Application Sent Hello, Please find attached the issued building permit. Please review any conditions and reach out should you have any questions. Inspection request instructions can be found on the permit. Admin - Hannah Hardwick City of Arlington Fire Permit Technician II hhardwick@arlingtonwa.gov 360-403-3549 Manual Closure - Permit#26-0301 Location:18513 59TH AVE NE- by Admin - Hannah Hardwick- Fire Permit Technician II at July 15, 2026 12:43PM Status: Closed Activity Type: Documents Review The following permit has been closed manually. Permit#26-0301 Location:18513 59TH AVE NE X Department: 1st Review Building - Deadline: May 15, 2026 - Status: In Progress ✓ Department: 1st Review Fire - Approved: May 11, 2026 - Status: Approved Permit Application #A26-0301 Location:18513 59TH AVE NE- by Steve Goforth -Assistant Chief/Community Risk Reduction at May 7, 2026 03:53PM Status: Approved With Conditions Activity Type: Application Sent Operational Permit 105.5.16 Explosives and Chapter 56 and NFPA 1123 Code for Fireworks Display. Annex F NFPA 1123 - Fireworks displays conducted during burn bans require that any combustible areas or dry vegetation within the display site should be wed down prior to Display. A minimum of two (2)fire watch personnel shall be available during the display and for fire watch for a minimum of 1 hour after. Fire Personnel shall have access to firefighting equipment and to be trained in the use of the equipment. Sustained winds of 25 mph or more will be cause to cancel the Fireworks display at the discretion of the NCRFA Fire Code Official or his/her designee Steve Goforth North County Regional Fire Authority Assistant Chief/Community Risk Reduction sgoforth@northcountyfireems.com @ Community Development Online Portal Page 2 of 4 July 15, 2026 12:45PM WASHINGTON 360-629-2184 Permit Application #A26-0301 Location:18513 59TH AVE NE- by Admin - Hannah Hardwick- Fire Permit Technician II at May 11, 2026 09:30AM Status: Approved Activity Type: Application Sent Steve approved with conditions. Conditions have been added to the conditions tabs Admin - Hannah Hardwick City of Arlington Fire Permit Technician II hhardwick@arlingtonwa.gov 360-403-3549 @ Community Development Online Portal Page 3 of 4 July 15, 2026 12:45PM 4rtk( tot( WASHINGTON Record Actions New Permit Application #A26-0301 Location: 18513 59TH AVE NE By Admin - Hannah Hardwick- Fire Permit Technician II at April 17, 2026 11:47AM Hello, A new permit application has been submitted for review. Please login to your CIVICGov Web Application account and visit the link below to view the permit details. https://www.civicgov4.com/wa_arlington/permits/details/429 If you cannot click on the link above, please copy and paste the entire link in the browser address bar. Sincerely, CIVICGov Team. Condition #1 Added By Admin - Hannah Hardwick- Fire Permit Technician II at May 11, 2026 09:29AM Condition: Operational Permit 105.5.16 Explosives and Chapter 56 and NFPA 1123 Code for Fireworks Display. Condition #2 Added By Admin - Hannah Hardwick- Fire Permit Technician II at May 11, 2026 09:29AM Condition: Annex F NFPA 1123 - Fireworks displays conducted during burn bans require that any combustible areas or dry vegetation within the display site should be wed down prior to Display. Condition #3 Added By Admin - Hannah Hardwick- Fire Permit Technician II at May 11, 2026 09:29AM Condition: A minimum of two (2)fire watch personnel shall be available during the display and for fire watch for a minimum of 1 hour after. Fire Personnel shall have access to firefighting equipment and to be trained in the use of the equipment. Condition #4 Added By Admin - Hannah Hardwick- Fire Permit Technician II at May 11, 2026 09:30AM Condition: Sustained winds of 25 mph or more will be cause to cancel the Fireworks display at the discretion of the NCRFA Fire Code Official or his/her designee Manual Closure - Permit#26-0301 Location:18513 59TH AVE NE By Admin - Hannah Hardwick- Fire Permit Technician II at July 15, 2026 12:43PM The following permit has been closed manually. Permit#26-0301 Location:18513 59TH AVE NE ©Community Development Online Portal Page 4 of 4 July 15, 2026 12:45PM �`� CERTIFICATE OF LIABILITY INSURANCE DAT4/(17/2026rr) 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 Great Lakes Partners Insurance Services aHONNo Ext: 216-658-7100 FAX No:216-658-7101 223 West Grand River Ave#1 E-MAIL Howell MI 48843 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Chesapeake Employers Insurance Company 11039 INSURED 18234 INSURERB:Palomar Excess and Surplus Insurance Company 16754 Western Display Fireworks Ltd.P. O. Box 932 INsuRERc:Continental Indemnity Company 28258 Canby OR 97013 INSURERD: HDI Global Specialty SE INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:531571975 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 B GENERAL LIABILITY AESPLMR-GL-26-00002 1/15/2026 1/15/2027 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 PE� LOC $ C AUTOMOBILE LIABILITY BESCRMNOR011601 171223 01 1/15/2026 1/15/2027 COMBINED SINGLE LIMIT Ea accident $1 000 000 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 D UMBRELLA LIAB X OCCUR 25QS1556 1/15/2026 1/15/2027 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ A WORKERS COMPENSATION 8025102 1/15/2026 1/15/2027 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I ER 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 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:7/4/26 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 9* ©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 i - 300' r `, Fall Out Area Fall Out Area r ♦ r 1 330 350' r r y � 1 r a Discharge Site EF r r .� 20'x10' Fall Out Area Fall Out Area r� .•�'` 1 1 310' o , Western Display Fireworks LTD. Bill Quake Memorial Park—Arlington,WA 1- - - Discharge Site 20'x10' 48'9'56.05"N 122'8'58.36"W Spectators UPDATED 10/16/2024 � �'SN\MCTOM JT�Tf Washington State Patrol Fire Protection Bureau 11736P Office of the State Fire Marshal yrotechni Operator License f�4RJXAlK 0� Li 1 Licensee Data WASHINGTOI �'TATr AAT11)/1t Jeshua Gabelein Phone Number: (360) 384-8226 9429 Avon Allen Road Email Address:jgabelein@hotmail.com Bow, WA 98232 Date of Issue: March 2, 2026 License Number: P-04364 Date o Expiration: January 31, 2027 VState Fire Marshal Licensee Signature 3000-420-043(10/18) Licensee Wall Mount Card ,*ON\NGTON JT'Tf Washington State Patrol Fire Protection Bureau 11736P .g, Office of the State Fire Marshal Pyrotechnic Operator License f*443HAL'S OFF Li U Licensee Data Jeshua Gabelein ,.,WASHING TON QTATI / TC3n1 Phone Numbe.&1, 360) 384-8226 9429 Avon Allen Road Email Address:jgabelein@hotmail.com Bow, WA 98232 Date of Issue: March 2, 2026 License Number: P-04364 'Date of Expiration: January 31, 2027 1111111111111111,1111iiiw,,�iiiiiiiillll'/L.��Li State Fire Marshal Licensee Signature 3000-420-043(10n8) 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. 3) All four cards constitute an entire license for a single operator. 1 17361) 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 must carry either the wallet(landscape) or the lanyard card(portrait). Washington State Patrol Fire Protection Bureau License Number: P-04364 Pyrotarhnic Operator Pyrotechnic Operator License _-Licensing Type Washington State Patrol � I�ss;�a-ak .�[a7id11atiil Fire Protection Bureau 11736P VVAS;4+i�i(-TC T T,e PATROL rTRC' January 31,2027 v t V tieshuatiabeiein Current[Valid Until Flyrote0pnic OpV4qQr State Fire Marshal Licens Signature � 3000-420-043(10/18) OPERATING PERMIT APPLICATION Department of Community& Economic Development City or Arlington• 18204 59th Ave Nl'_• Arlington,WA 98223• Phone(360)403-3551 Part I Applicant/Building Information Applicant's Name: )&]elfcems ` ,SPIay F.`{' -Wc9 (V-S ., L4J. Applicant's Address: FAO �3 Z� Ca/1�,� Q'70 3 Contact Person: Dewi' 1 P�P0 pen Telephone: jgg9 Address of Premises for which Operating Permit is requested: ❑ Same as above ® Other (specify): ( K4ke I?e►fk l$5-Ott 5"9"AV- AJgT/4ftin��T{nN4, g8L25 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 or iandli4> >azardous 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): l7� ,)M See- a AnGW 54t t �— Rev ised 4/1/08 Page 1 of 4 I _ 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): Q 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): gee- almwkud r,6( Coto f- ACC1a1 .('t t[S D S ❑Aboveground Storage Tank(AST) (see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary tank closure ❑ Changes in service ❑ Permanent tank closure Brief description: ❑ Underground Storage Tank (UST) (see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary tank 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. 7//7/Z6 G Signature of Applicant or Authorized Representatives Signature Date 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 ��N�NGTON B�'rF Washington State Patrol Fire Protection Bureau G24730 Office of the State Fire Marshal General Display Fireworks License ,F�'�RANAL'�OFF F 1 L. Licensee Data Operational Data Western Display Fireworks, LTAINGTON kln State Agent: Incorp Services, Inc. Ll Post Office Box 932 Phone Number: (503) 656-1999 Canby, OR 97013 Email Address: heather@westerndisplay.com ; brent( License Number: C-013 6 Date of Issue:January 13, 2 226 ate f f xpiration:January 31, 2027 State Fire Marshal Licensee Signature 3000-420-041(10/18) �*yH1NMtki ArF Washington State Patrol Fire Protection Bureau G24730 W. Office of the State Fire Marshal General Display Fireworks License �+FrAR3NA4`E Lj Lj1 Licensee Data IAIn Operational Data��� Western Display Fireworks, LT5HINGTON 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 13, 26 Date of Expiration:January 31, 2027 ' State Fire Marshal Licensee Signature 3000-420-041(10/18) -------------------------------------------------- � HING70Mgr'rF Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal General Display Fireworks License Licensee Data MA SHINGTON Operational DataTlPr)l Western Display Fireworks, LTg2k26 In State Agent: Incorp Services, Inc. Post Office Box 932Phone Number: (503) 656-1999 Canby, OR 97013Email Address: heather@westerndisplay.com ; brent( License Number: C-01316 !I Date of Issue:Jan�uaryDate of Expiraton:January 31, 2027 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 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, 2026 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 3/13) SHOW SHELL COUNT SPONSOR Arlington, City of SHOW#7896 SHOW NAME Frontier Days SHOW DATE Sat,July 4, 2026 TYPE OF SITE LAND SHELLS 2.5" SHELLS 6" SHELLS 326 3" SHELLS 8" SHELLS 4" SHELLS 10" SHELLS 5" SHELLS CAKES, BOXES, CANDLES, SINGLE SHOT, & MODULAR ITEMS 1.75" AND SMALLER CAKES 5 2.5" BOXES 5 1.75" AND SMALLER ZIP/ FAN CAKES 2.5" FANNED BOXES 2" BOXES 3 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 4/17/2026 10/1305