HomeMy WebLinkAboutBLD-2015-0618 - TANK REMOVAL City of AltaCorteS Invoice/Permit#: BLD-2015-0618
' 904 6th Street
Applied date: 11/18/2015
" I P.O.Box 547
7 Issue date: 1 11 82 0 1
to Anacortes, WA 98221-0547 Expire date: 11/12/2016
Y= .4`40I, s3 (360) 293-1901
Job Address: 1019 12TH ST Permit Type: Demolition Permit
ANACORTES WA98221-2101 Project:
APN: P55112 -
Remarks: Decomission removal of(1) 550 Gallon underground heating tank.
Owner: LIGHTHOUSE BAPTIST CHURCH ANAN Contractor: ULTRA TANK SERVICES
Address: 1019 12TH ST Address: PO BOX 30096
ANACORTES WA98221-2101 BELLINGHAM WA98228-2096
Phone: Phone: (360)815-5361
License#: ultratso33ck
General Information: Fees:
Total Calculated:
Adjustments:
Deposits/Reoeipts:
Total Due:
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. 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, THE
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF OWNER ORAUTHORIZED AGENT ISSUED BY
CITY OF ANACORTES
1 DEMOLITION PERMIT APPLICATION
Site Address: I(J 4 `1 I;m
Assessors Account No.: 3 779—-0 q I —010 —WO 2 Date: 1
Lot(s)7 10 Block: Y I Addition: qi M
Owners Name: W FA4T783- Contractors,Name: -r ` - C=3 hr,
Address: /D 19' /2 i}l 572tvi A�/9 dress: If/0 x -Z300 4 t it/U6,4,
State: jiZIA Zip: 9T .2� State: Lk)1:1 Zip: V�i '29
Phone: 2S3 20 ab9' C Contractors License:ZJQ—F '-f`✓ 07 3C K
Phone: :?Cl) W/Lc'-rS 3t /
Have Utilities Been Disconnected? Description of proposed demolition.
Water Dept: Yes No OI omm rssimj MY Lyi/4L or- 6 )
Electric: Yes No
Cable: Ye No S"3`� G�Y(,,L=/ (GA/03o/C(rl2fXf�lJ7 h l7lA/G OIL 7j�I/!�
Gas: Yes No How NY/ill Materials be disposed?
ys7W AGi^ YL SiTJ�y Aato
BARRICADES TO BE PROVIDED FOR PUBLIC PROTECTION,AREA MUST BE
ROPED OFF!
Applicant's or Agent's Signature
ASBESTOS WARNING
Breathing asbestos is hazardous to your health. Before starting a renovation or demolition project,
survey for friable asbestos materials. Notify Northwest Air Pollution authority prior to asbestos
removal or containment 1600S.Z,d Street,Mt.Vernon(, ,,V,A�98273 (360) 428-1617.. y�
Fire DepartmentApprop>ah 00 Date:
7LI
Police Dept.Approval, Date:
Public Works Department Approval: Date.
museum: Date:
Comments-
Grace, Michelle
From: Ultra Tank Services,Inc <ultratank2012@gmail.com>
Sent: Tuesday, November 17, 2015 4:02 PM
To: Swan, Sharon
Cc: Grace, Michelle;tompulver@hughes.net
Subject: Permit application 1019 12th St Anacortes
Attachments: Permit application 1019 12th St Anacortes.pdf
Hi O
Attached to this email is the Permit application and site map for 1019 12'Street,Anacortes. Let us know if you need
anything else.
Thank you,
Jan Pulver
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f C$C14t b�nfeasmld Faeg4dlW tie�r6.`I
Jan Pulver
-Ultra Tank Services, Inc.
P.O. Box 30096
Bellingham, WA 98228-2096
Ultratank2012CU�gmail.com
www.u Itratankservices.com
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