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_FRRTRNK FAX NO. :3603981807 Jul. 22 2003 03:29PM P2
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<br /> Site Address: J R ( t 2 yam` 5€ Date: 7- 22-o 3
<br /> Assessors Account No.:
<br /> Lot(s): _Block: Addition:
<br /> Owners Name: ,Qr fires -av z).-t,an, Contractors Name:s tf.-g"9"0...l� Seut,Pz.t$
<br /> Address: /4t? 2q111" St . 4.,a ,.S Address:
<br /> State: ,LOA Zip: 9t z.a..( State:JA 1,4- Zip: 9€z27
<br /> Phone: t 34.o - 2_9 3 ^ 74f.2fl Contractors License:4t4-r+ 4-50SY C&
<br /> Phone: -?3V-?6 it
<br /> I-Have Utilities Been Notified? Describe Work & Tools To Be Used. How Will
<br /> Materials Be Disposed?
<br /> Water Dept.: Yes No ;t(;„1. c “c4.4.1 e 7( `t"
<br /> Electric: Yes No w:44-- S a.t L
<br /> Cable: Yes No
<br /> Gas: Yes No
<br /> Phone: Yes No
<br /> •
<br /> BARRICADES TO BE PROVIDED FOR PUBLIC PROTECTION,AREA MUST BE ROPED
<br /> OFF SEE SECTION 4409 U.B_C_
<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 containment.
<br /> 20I Pioneer Bldg., Mt. Vernon, WA 98273, (360)42Y 1617 i
<br /> •
<br /> Fire Department Approval:, :::; 4lz 7 — Date: -7-_r ..�
<br /> (Fire Chief or Fire Marshal)
<br /> Police Dept. Notification: Date:
<br /> Public Works Dept: ��, Date: ' 2-8"-G3
<br /> (Speed Garrett)
<br /> Comments:
<br />
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