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Mar 23 10 02:48p Ultra Tank Services 360-398-2311 p.2
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<br /> Site Address: .2-411 L... /14-L .54- • Date: 3 .2_3 - /0
<br /> Assessors Account No.:
<br /> Lot(s): Block: Addition:
<br /> Owners Name:...3";1/4,,,, 'Vs% t le....c.,-5 0 v., Contractors Name: UT 5 ---rn-(.._.
<br /> Address: it-0 2._. i 2-4 Sr' . Address:P-e 00 ki 300 Y 4,0
<br /> State: to A- Zip: fra i State: u)A• Zip: 7 s--2,Le
<br /> Phone: Contractors License: u I 1-r-a_..1-ssz
<br /> Phone: Ge')--ets-- 75-4 0
<br /> Have Utilities Been Notified? Describe Work& Tools To Be Used. How Will
<br /> . Materials Be Disposed?
<br /> Water Dept.: We; No tn.&r--cr-unJ de Cc,nal.; .5 S(o vt e r::- tie )
<br /> Electric: Yes No ay.e -goo G cil or.. C it.o.Ard ts•rr- r-n N...A-o--A .
<br /> Cable: Yes No Vito-1:1-m e`i ( -Tra V-_. . _.S a eLl RV
<br /> Gas: Yes No
<br /> Phone: es No
<br /> BARRICADES TO BE PROVIDED FOR PUBLIC PROTECTION,AREA MUST BE ROPED
<br /> OFFirittriimil , SEE SECTION 4409 U.B.C.
<br /> , So-br-g- tattediz- caPP-- arS CfriC, ,
<br /> (Applicant's or Agent's Signature)
<br /> ASBESTOS WARNING
<br /> Breathing asbestos is hazardous to your health. Before starting a renovation or demolition project, survey for
<br /> friable asbestos materials. Notify Northwest Air Pollution Authority prior to asbestos removal or oantairtment.
<br /> 201 Pioneer Bldg., Mt,Vernon,WA 98273. (360)428-1617
<br /> Fire Department Approval: . Date:
<br /> (Fire Chief or Fire Marshal)
<br /> Police Dept, Notification: _Date:
<br /> Public Works Dept: -> ACKIAM\.% CMC
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<br /> (Speed Garrett) r-
<br /> r,-..--- Date: .5, Z.
<br /> Comments:
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