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In the space below, draw a diagram of the grounds on which the display is to be held, showing the point at <br /> which the fireworks are to be discharged, the location and distance from place of discharge of all buildings, <br /> higways and other lines of communication; the place behind which the audience will be restrained and it's <br /> distance from the point of discharge; and the location of all nearby trees, telegraph or telphone lines or other <br /> overhead obstructions and their distance from the point discharge. <br /> see attached aeiral showing launch location &fallout setbacks <br /> Name of licensed pyrotechnic operator who will supervise discharge of fireworks License no. <br /> John Fisher-cell: 425.239.4819 P-02764 <br /> Name of assistant to pyrotechnic operator License no. <br /> Jim Fisher n/a <br /> Proposed display will conform with all the laws and regulations of the State of Washington and the Everett <br /> Municipal Code. Permittee shall be responsible for compliance with the provisions under which a public <br /> display permit has been granted. <br /> Signature of Applicant Date signed <br /> 2041 V-4---- <br /> 5/13/2016 <br /> Approved by: (Signature of Fire i f or designee) Dat sign <br /> 3 r3 �-- S�/l'q /� <br /> 3 ,. ss��,y�` month, ate, year) <br /> NOTICETO APPLICANT <br /> Your application must be filed with the Everett Fire Department at least 30 days prior to the date of the <br /> proposed display. Documentary proof of: Surety bond; public liability insurance; or a director of fire <br /> protection's"general license"for the public display of fireworks must be attached to this application. <br /> Inspected and approved b ilt Apr./ / , Date t alp <br /> AT ST: t +JVED AS TO FORM <br /> City Clerk <br /> --JA-MES U. ILES, City Attorney <br />