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li <br /> p ,M (",. 1F fl wm.:13, <br /> wilt' , <br /> CITY OF ANACORTES ..,' <br /> 1,-- <br /> 7 . <br /> DEMOLITION PERMIT APPLIC, .f u4dc i 11 <br /> Site Address: 2 2 O2 �J � r') tA CC�6�L. S t-GCJYP C TES <br /> Assessors Account No.:33512 - 20( - 020 - 0009 Date: <br /> i <br /> (P56.2G0) <br /> Lot(s):5_2 t-) t l el(9,20 Block: -WC, Addition: <br /> L.4.“yDc3> Cth�`t <br /> Owners Name:Lit AkAcc t-=.� Contractors Name: v e-r� t-t�t�T <br /> Address: CAI- C.• FAl P-MAU Ei pt SC A-Address: S - E 2 i4Au .p v,-, <br /> State: Iit y�►sutsAc11fa : crT3233 State: w YKuC2.�N ip: 90232, <br /> Phone: "3C0o-1 SS-.i 02I Contractors License: LA A 26.1.0O(,2D.4- <br /> Phone: 3 --775 -Gv2.1 <br /> , <br /> Have Utilities Been Disconnected? Description of proposed demolition, <br /> Water Dept.: Yes No --/Vit t-t C7\/E EN-Ls-Tit-1 ct i--t l- C---- <br /> Electric: (D No <br /> Cable: Yes No { 5 U t L,D t t-i q <br /> Gas: Yes No +'' #,,,, <br /> How Will IM�Iate ials be disposed? <br /> /5 Viz-ra "1-3 <br /> BARRICADES TO BE PROVIDED FOR PUBLIC PROTECTION,AREA MUST BE <br /> ROPED OFF! �,- <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, <br /> survey for friable asbestos materials. Notify Northwest Air Pollution Authority prior to asbestos <br /> removal or containment 1600 S. 2'1 Street,Mt.Vernon,WA 98273 (360) 428-1617. <br /> P/;/ <br /> Fire Department Approval: • '1 l/�!' Date: 7r`�' <br /> Police Dept. Approval: /Date: <br /> Public Works Department Approval: Date: <br /> Museum: <br /> Date: <br /> Comments: <br /> t <br />