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<br /> 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 /> Name of assistant to pyrotechnic operator License no.
<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 /> .V6041 5/18/2010
<br /> Approved by:(Signature of Fire Chief or designee) Date signed
<br /> (month,date,year)
<br /> MISSatila��`;t` _Yid..giMVSNOCA-r.OA��PLIC'ANTNOM��:�..:�,.��,M`OMeant.
<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.
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<br /> 111
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