HomeMy WebLinkAbout19002 59th Dr NE_006943_2026 C I T Y OF AFRL. I NCCTON
C O N S T R LJ C T I C3 N P E R M I -T
PERM I T NQ_ _ 006 —f6943
Ovner: JOHNSON, STEPHEN 24005 13TH AVE NE ARLINGTON 98223
Value of Work: Tax ID: Phone: 360. 435. 8181
Describe Work: DEMOLITION
Proposed Use: DEMOLITION
Legal Description:
Job Address: 19002 59TH DRIVE HE
Contractor's Name Type Address License#
LANCE HARVEY GEN 10325 AIRPORT WAY LANCEHT000JR
TOTALS Fee C Q n!� wri
Permit Fee $100. 00
State fee $4. 50
SI AT RE:
TOTAL FEE. . . . . . . . . . . . . . . . . $104. 50 I E EBY CERTIFY THAT I HAVE READ
AN ANINED THIS APPLICATION AND
PAYMENTS. . . . . . . . . . . . . . . . . $0. 00 KH W HE SAME TO 8L TRUE AND COR-
REC 4 LL PROVISI N5 0 LAWS AND
TOTAL DUE. . . . . . . . . . . . . . . . . $104. 50 O D N NCE OVE ING HIS TYPE OF
W R ILL C LIE IWITH WHETHER
S • II�D R T.
DATE RECEIPT #
B IL ING OFFICIAL
4, "o
``YU DEMOLITIOf' ',
� PERMIT APPLICATION
�NGS Department of Community Development
City of Arlington • 238 N Olympic Ave. •Arlington, WA 98223 • Phone (360)403 3431 • FAX (360)403 3447
THIS APPLICATION MUST BE ACCOMPANIED TWO(2)SETS OF FULLY DIMENISIONED PLOT PLANS AND SITE CLEAN-UP
PLAN, TWO(2) COPIES OF AN ASBESTOS ABATEMENT REPORT COMPLETED BY AN APPROVED AGENCY.
Type of Permit: (check one) ( ) Residential }� ( )Commercial
Project Address: I IFOO 59 D ` Parcel ID#:
Lot#: 45 O Subdivision:
Building Area(Sq Ft) ` `� No. of floors: Number of Buildings: )
Owner: Phone Number:
a
Address: ay SOS �� PhA—VO U City: State: Zip Code
Contact Person: l �C Phone Number: 349Q- z17 (1 — l 3
Cell Phone: u�-<Z <,ZrV` �l lQ3 Fax: E-mail:
Address. -j I�DI� Gl �y rt.i� - City State: Zip Code:
Scope of Work:
Contractor: -Fe Phone Number: 34cf— -5'�U 1 40/01
Address: /D3 2� Od le PC rr- &," City: v1 State: 6U9-,0'( Zip Code: 4
i A
Contractor's License Number: IUC. L H l 6) 0 JT Expiration:
I hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the above-
described property will be in accordance with the laws, rules and regulations of the Stat of Washington.
Applicants Signature Date
/` RECEIVED
Print Applicants 11ame
MAR 2 12006
COA PERMIT CENTER
FOR STAFF USE ONLY
1,
Pv'
rr it# 11 Accepted By Amount Received Receipt# Date Received
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