2003, 10-10 Notice of Hazardous ConditionsVISTAW
Utilities
NOTICE OF HAZARDOUS CONDITIONS
Customer Name
Address
TYPE OF
NOTIFICATION:
Equipment Type:
CONDITIONS
FOUND:
S-0308 (06-01)
Phone Number
City
U HAZARD The conditions noted below constitute an immediate hazard and may result in property damage, personal injury, or loss
of life. The equipment has been disconnected or left inoperable, and shall not be turned back on until such repairs have been completed
by a qualified HVAC dealer, contractor, or service agency, and the equipment has been brought up to current safety standards. Do not
attempt to use this equipment until it has been repaired.
Location:
❑ Apparent cracked or restricted heat exchanger ❑ A gas leak in your house piping in the amount of
❑ Damaged appliance connector
❑ Damaged or disconnected vent
❑ Gas leak at gas equipment
with all known appliances off
ia Insufficient combustion/ventilation air
IQ Other
CFH
f
Meter Left ❑ Off ❑ On Meter Number
Meter Read
I have read, understood and acknowledge receipt of this notice. ❑OwnerJenant ❑ Agent
Customer Signature ,�' ❑ Refused to Sign
Service Representative y Date Time
White Copy— Customer Yellow Copy— Attach to Service Order Pink Copy—Authority Having Jurisdiction Hard Copy—Appliance
am/pm
0
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I:3 Projects
Project It Search Project Name Search: Grow Name Search:
91006946 :J 1
Sge. 28246 Group. NO Name:
INSTALL HEATING EQUIPMENT & PIPING Dist: F BOBBY STONE
Invoice Status 1 Fees
Actions Site Address
Site Adthesses
Payment History
Contacts Team
Billing Bonds
Milestones 1 Lags
1 Inspections 1 Renewals
Condition: 1 Characteristics
Owner Name 1 Occupant Name
Site Address 1 Address 1 Address
Parcel Number City, State, Zip City -Stale -Zip City -State -Zip
GIS
13210 E NCH AVE COUNCIL, STEVE & LORRAIUI
SPOKANE, WA 99216 13210 [P101 AVE
0 SPOKANE, WA 99216 SPOKANE, WA 992
Phone (509) 9214483
DOB
Record: Hi 1 'Hi I of 1
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Thursday, Dec 11, 2003 1121 AM
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