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09/27/2002 04:06 3602936756 PAGE 01 <br /> s iT7 ofE fit t P p <br /> r. <br /> ate, e t.cmf' H...r & .. ^' S"- Y --' ....- <br /> artkria <br /> \v...4 'uGv" ,ze .� SNP £ ^' i `"a—ut', :, . `'" 7 <br /> '�� YAM 3.rh[Mir Pi 1 `" Fi 4i ,tf b � , ' :NJ c� p <br /> 33 4 <br /> \ aR w�nhri✓.w.rvn4 rti. � "....'.a: .....__ z 4;;R <br /> Site Address: f U/e S C Date: fir , 3 <br /> Assessors Account No.: '.3flY. -0O2 007 0003 f P5-73/S <br /> Lot(s): 5 7o 7 Block: 2 Addition: #6,1457-FeiS /sr7d /v, L <br /> Owners Name: ate JJ/!<-,*vrc .-Contractors Name: a,vn-A4:off 3 a,,d- <br /> Address: �l A�O9 1p. 'le— R1& Address: U a V6 '7 a d s <br /> n e L -� i <br /> State: Y�A— Zip: I 9.2-/ State: j1 Zip: 9 d z,- / <br /> Phone: 360 • 93 • -6 Contractors License: (000 097f•r33i <br /> Phone: 3 6 e i 2'�3 - 67 S, <br /> Have Utilities Been Notified? Describe Work &Tools To Be Used. How Will I <br /> Materials Be Disposed? <br /> Water Dept.: s No <br /> Electric: 10i No t --X C?1/A-rya- --fi UOgr' - <br /> Cable: No Pr4.Q—te.a 7 <br /> Gas: ¶ No tt / w i S 7ii Fr- S6h,G <br /> Phone: No <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). I <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 /> 201 Pioneer Bldg.,Mt,Vernon,WA 98273. (360)42 -1617 <br /> Fire Department Approval: e Date: f/—�`C5� <br /> (F'ire,Chief or Fire Mars <br /> Police Dept.Notification: Date: <br /> Public Works Dept „e14 W Date:�' 6 1 <br /> (Speed Ganen) . <br /> Comments: <br />