I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL
PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN
OR NOT.
**BY LEAVING THE CONTRACTOR INFORMATION SECTION BLANK, I HEREBY CERTIFY FURTHER THAT CONTRACTORS (GENERAL OR
SUBCONTRACTORS) WILL NOT BE HIRED TO PERFORM ANY WORK IN ASSOCIATION WITH THIS PERMIT. (building permits only)
____________________________________________________
_______________________________________________ DATE: ______/_____/_____
SIGNATURE OF OWNER / AUTHORIZED AGENT PRINTED NAME
City of Sumner
Tempora
ry Use Permit
Application
(Please fill out ALL fields unless otherwise noted)
Supporting Materials Required:
Offi
ce Applicant - (please check off all “applicant” boxes)
This Application Form and Checklist - pdf copy of all required documents
Site Plan
Building envelope with building setbacks
Streets in relationship to the proposed Temporary Structures
Parking configuration
Accessible spaces
Location of fire hydrants
Temporary Signs – Location and size
Other items (e.g. stage, rides)
Fire access lanes
Temporary Structure Floor Plans
Table / Chair set-up
Exit paths
Fire Extinguisher Locations
Certificate of Flame Resistance
Permit fee
Site/Project Address (if available): Parcel #:
Owner: Phone: Email:
Owner Address: City: State: Zip:
Surveyor/Engineer/Contractor: Phone: Contractor License Number:
Address: Email: City: State: Zip:
Contact Person: Phone: Fax:
Contact Address: Email: City: State: Zip:
Description of Project:
Community Development
cd@sumnerwa.gov
(253)299-5530
www.sumnerwa.gov
File Number: _________________________
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signature
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