2000 HEWITT AVE EVERETT EVENT CENTER 2023-11-28

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 Disney On Ice Street Address 2000 Hewitt Ave City Everett County Snohomish Event Date Nov. 2-5 Event Time Attached ❑ AM ❑ PM Applicant's/Sponsor's Name Pyro & Fire FX LLC Phone No. 253-307-5118 Pyrotechnic Operator Tommie English License No. P-04508 Experienced Assistant's Name Keizo Osuga General Display Company Name Pyro & Fire FX LLC Phone No. 360-649-4503 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. Authority Having Jurisdiction Name of Permitting Official Title Permit Granted: ❑ Yes Restrictions/Notations Signature of Permitting Official Local Fire Code Authority Phone No. ❑ Yes, with Restrictions (see "Notations" below) ❑ No 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)