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HomeMy WebLinkAbout07060083 Temp Use Application ,c I I C \J\x:Llmcnl,..lld cllin~s\J im 1 f'I,IJ \H',il-"""(linel',:\icmpOI';.l.I)' Illl'~I'It\:l (-ilo':l'\,:\I:"'I,~nt rr'i\IT:;"J,:J(X\l:irework<; ~;pc.:iJ.1 FVr;;Il.T.~_Applk.ltionll,I_~nc I CITY OF CARMEL. INDIANA, DFPARTMIiNT 01' COMMUNITY SERVICFS TEMPORARY USE APPLICA nON FIREWORKS SALK8 OR SPECIAL EVENT mVISON 01 ilL.! I LDI NG AND CODE ENFORCEMENT INCOMPlETE APPLICATIONs W 11.1 ORA Y PERMIT Rl::V II::W, A -PPLICA 'rl ( WNER INFORMATION (I-'IFASE PRINT OR TYPE) COMPANY MI:l c,{S/? fi,-",W'"&,-/, l ,,/.";-.:. A1'1'11( ANT INAMt r. '"""m l '" ~, ADDReSS otFPP ILANT: ...l'Jt~ 7' ,;, l:::"""-/,...4,,,,, Almll,.!:S:,. PROI'FRTYI NI R NAME f..'~-~".~ -I,'f~'h' ADDRess OFlow ER 'ILt"j; 5;:~?-,<,".-.. 7; .~-I AntJRE:i:i -- TEMPORAiRY SH INFORMATION P~1UNI: /1: ( ;i? ) S~6' .J-T.2 2~1 l'AXff: ( 'tI).1 ~ ttf p;:'::;>' d -- , lie'.:"'.); .J.;"f"./.~'"",-~.k';; ,.: c-i'h ~~/-/ -;'ATr:: ,,:u'('om.. PIIONF ff ( :1!;;>' ) 2'7:; -'i5J"j ? .;j.-r' .f-.~--,~I!.:. ';'1 :\'1'1 _ll' l, "('if')r:-- _7:.:,,~,.t';:"'''''j'I,..,t:i -. C'ITV'-' S/ORGANIZATION _ Vi,!4 I:,:-~--',<~'i<..:t PO!tARY USE 137.0. ,{'p"J'" I,'"" ;'Cd... [a "M! ...L;'~ nATE(S)OF ~ROP SLD IJSF 6'/ t/c.:;- ;} /.p/'e;,? HOURS OFOPERATlON 94/'1.-/<>/~ DESCRIPTfOr)! IUvlPORARY USF ;t~ l"" 5-> I~-.,.~-~ f: ,,__.' -,f." WILlIHI' ~MP( RARYl1SEBEOIITT)()()RSl \:ES "'~-)' Will nil j MP( MRY USE REQlJlKI A STR1)CTURU (Ic'nt, stand, or Olohil,- """) YI;5 orCl'lOJ II'S() WHA TYP OFS'lRll(TUREANl1lNDICATI:SIZI' _, ('NOlI: MOBI F IINIT REQUIRI:MlNTS ON IlACJo:') MOIlILSl.!l<1IT CFRTfF1CA1ION II Will IHFT MPI,RARYUSEIITlTllFA I LMI'OI(ARYSk;Nl (YE$;.'nr NI) (> NOn I I MljORA Y SIGN REQUII(I'MI'N IS ON BA'~t-:.) !E~PI'I.lCATl()N 1 !'OR FlREWORKSALLS (J'L/:A"f REfER II) !JOITlONAI APPliCATION RJ;~UjREMEN I S I IlR rtREW\lRKS S^lES IlN IlACK) "...,.. WILL THI: S' RII( rl1RE Ill: l)SJ;'D POR THF SAft, (1I MORE THAN 500 IIR.C, OF 1;lJ;LWORKS< YES orOil}) 1101'S 'Till 51 RU RE ALRFA1W HAYI, A SPRINKLER SYSTEM INS I AI.II'I)>(\'F,5','r NO__, HAS THIS STRUC RI: PRIVIOllSLY IlEEN USED FOR IIII' SAI F OF FIRFWO'[KS' y~S nr('!(t CEltTl!,ICAl'lON ND NonCE OF lNTFNT TO COMPlY J had)y certHy !lal I 1;1\1(.' the ,\lIthotil.y to m"kc the !nl't.g(lIn~ ;lpplicttkm, t:h::n thl..' itpplic:.ltiCln :lnd ptms bled ...viLh the ilppliL'rlcion i.m: (11rn.'cl, and r./'ut the ( T:tti()n ;Jlld l'tlmlul..:t of [he n::ml'lornry lItiC will t'nl'llnrm tn tbe I'exubt iont> or Carmdt(:, Zll111ng ()[dill,lIlU~. f'IREWORKS SALES o SPECiAL EVENT --~.~ ~~ -- - ~----_. ~iijlil(~~' (11 ^pp'- ';\n('( P"f))' ..). " OFFICE USE pNL (OU NOT WnrrE IN) PICRMIT II: 7OCPl'08..Q ZONING API'UCATIOt RI' Jl'WW!lY: t<!3. 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THIS CERTIFICATE :DOES NOT AMEND, EXTEND OR ALTER THE COVEFlAGE AFFORDED BY THE POLICIES BE~OW I NAIC# I I- I INSURERS AFFOROING COVERAGE - INSURliO Wl.'I'.'.J Fir:,wol:kD 5,UjJ 'N" 91th Tfl S.Ji tr: 11" t'ri:l1ri~ Vi.lli;l~'.;.; I , 1 Inr-.Fl nat.10rle_ :~'~o<'- f LLC INl\lIRfR^ V;'X1Ill.)I.l.;lJ lJI~I_Li:::.1J/.'(.\ C'll Itr.lounE'nn 1N'.;UI1LlIC. INaUHI:.HU. 1I"~Ullt;llf: COVERAGes IJ1l1'. ?(lL,I('(tS m iN;:) JtANl.:t; J..l::!l'.I!;D E!!!',r.ow J'U\'I'E BEe>> I~;;:rED !~") T::.E. Hl3ult~lJ lllAM.!1.l AI:lOVH. wO" THI'", rOTT,"-( rF".nron TNDT(';:"HT.I. h'm'),!" rtlSrlttlt"ING ~NY 1l,J1:\)ut~.',r,1I1I"Nr , 'I ~',K'" 01' ':'OtlL11II0l\ 01' f,t~Y nlr\'TR,,\':i OR Oi!fF',~ nCC":rMfl".NT W-il1 IH'S~'F:-T TC 'ilI-TH'~ nn~ , ~:I\T n('AT!:. 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