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Recreational Fire Permit <br /> Anacortes Fire Department <br /> 1016 13th Street,Anacortes WA 98221 <br /> 360-293-1925 <br /> Applicant Information <br /> First Name* Last Name Phone* <br /> THOMAS KINGMAN (360)588-0150 <br /> Mailing Address* Email* <br /> 4512 Kingsway tengrugope@comcast.net <br /> Permit Information <br /> Fire Location* <br /> Enter street address if different from applicant mailing address <br /> 4512 Kingsway <br /> Material* <br /> Firewood <br /> Firewood is defined by Anacortes Fire Department to be natural vegetation cut into sticks of two inches or larger in diameter. <br /> Conditions <br /> ..................................................................................................................................................................................................................................................................................................................................................................................................... <br /> o Fire shall not contain prohibited materials i.e.,yard debris,garbage,dead animals,asphalt, petroleum products, paints, <br /> rubber products,plastics,paper,cardboard,treated wood,construction debris, metal or any other substance other than <br /> approved material(charcoal,firewood or LPG),which when burned releases toxic emissions,dense smoke,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 /> • Permit must be present on site during burning. <br /> Signature <br /> In accordance with the International Fire Code adopted by the City of Anacortes and regulations of Northwest Clean Air Agency,the <br /> undersigned does agree to take responsibility for this burning,if granted a permit by the Anacortes Fire Department. <br /> Signature <br /> Application Date* <br /> T90MA Y Z1,VgMAk 7/19/2022 <br /> ■ <br /> Approval <br /> Reviewed By* Application has been* <br /> SHARON SWAN Approved Denied <br /> Date Issued* Date Expires* <br /> 7/19/2022 7/19/2023 <br />