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�,pCO�RT�s Recreational Fire Permit <br /> Anacortes Fire Department <br /> 1016 13th Street,Anacortes WA98221 <br /> F.MS <br /> -4Re Des 360-293-1925 <br /> Applicant Information •• <br /> First Name* Last Name Phone* <br /> David Ellingson (503)302-5941 <br /> Mailing Address* Email* <br /> 6134 Parkside Dr <br /> Permit Information •+ <br /> Fire Location* <br /> Enter street address if different from applicant mailing address <br /> 6134 Parkside Dr <br /> Material* <br /> I. Firewood <br /> Firewood is defined byPnacortes Are Department to be natural vegetation cut into sticks of two inches or larger in diameter. <br /> Conditions <br /> o Fire shall not contain prohibited materials i.e.,yard debris,garbage, dead animals, asphalt, petroleum products, <br /> paints, rubber products, plastics, paper, cardboard,treated wood,construction debris, metal or any other substance <br /> other than approved material(charcoal,firewood or LPG),which when burned releases toxic emissions,dense smoke, <br /> or odors. <br /> o No burning shall occur during a"No Burn Day"as designated by the NWAPA or Anacortes Fire Department due to a <br /> forecast or existence of impaired air quality or other environmental conditions. <br /> o Firewood is defined by Anacortes Fire Department to be natural vegetation cut into sticks of two inches or larger in <br /> diameter. <br /> o Water source with garden hose and nozzle is required, a 2A extinguisher is acceptable. <br /> o Fires contained in an approved burner located not less than 15 feet from any structure. <br /> o An adult must be in attendance at all times. <br /> o Fire must be extinguished upon completion of the recreational activity. <br /> o Subject to Northwest Air Pollution Regulations. <br /> o Permit must be present on site during burning. <br /> Signature <br /> In accordance with the International Are Code adopted bythe City of Anacortes and regulations of Northwest Clean Air Agency,the <br /> undersigned does agree to take responsibilityfor this burning,if granted a permit by the Anacortes Fire Department. <br /> Signature <br /> Application Date* <br /> /{Q4a (( 9cfps 5/12/2021 <br /> Approval <br /> Reviewed By* Application has been* <br /> SHARON SWAN C' Approved r Denied <br /> Date Issued* Date Expires* <br /> 5/13/2021 5/13/2022 <br />