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I 3 <br /> I: APPLICATION FOR PERMIT CITY OF EVERETT <br /> PUBLIC DISPLAY OF FIRE DEPARTMENT <br /> 2811 Oakes Avenue <br /> FIREWORKS Everett, WA 98201 <br /> Permit No. <br /> Name of applicant Telephone number <br /> Wolverine West, LLC (206 )459-0917 <br /> Address of applicant (street and number, city, state and ZIP code) <br /> PO Box 99095 <br /> Seattle, WA 98139 <br /> If applicant is a corporation, give name, address and telephone number of the following: <br /> Name of President Telephone number <br /> ( ) <br /> Name of Secretary Telephone number <br /> ( ) <br /> Address of Secretary (street and number, city, state and ZIP code) <br /> Date on which display is to be Start time of display End time of display <br /> held (month, day, year) <br /> 9/30/2011 Half-time of football game <br /> Duration to be 5 minutes+/- <br /> 8:30pm+/- 8:35pm+/- <br /> Name of organization sponsoring the display, if different from the applicant <br /> Henry M Jackson High School <br /> Name of President Telephone number <br /> Judy Montgomery (425 ) 385-7105 <br /> Address of organization (street and number, city, state and ZIP code) <br /> 1508 136th St. SE, Mill Creek, WA 98012 <br /> Exact address location planned for display to be held <br /> Practice Field of Memorial Stadium-see attached aerial <br /> Number of set pieces, kinds of fireworks to be discharged, shells (specify single or multiple break) and other <br /> items to be used in display (attach additional page if necessary) <br /> All items are 1.4G Consumer Grade Fireworks: (30) multi-shot"cakes" & (64) 1.75"single-break shells. <br /> Manner and place of storage of such fireworks prior to the display. <br /> In our licensed magazines. <br /> 9 4 <br />