a&a carrier ----llc · utilities and transportation commission 1300 evergreen park dr. sw, po...

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APPLICATION FOR PERMIT Intrastate Common Carrier Operating Authority (excluding Household Goods) WASHINGTON UTILITIES AND TRANSPORTATION COMMISSION 1300 S Evergreen Park Dr. SW, PO Box 47250, Olympia, WA 98504-7250 Telephone : (360) 664-1222- Fax: (360) 586-1181- Email : transpo[email protected].gov FOR OFFICIAL USE ONLY Employee CC# Reception Number Insurance Carrier ID# 111-0268-200-02 ' - TYPE OF APPLICATION Defined in WAC 480-14-040 New Common Carrier Permit Authority, Extension of Common Carrier Permit Authority . or Transfer of Existing Permit Number $275 GENERAL COMMODITIES ONLY D $100 GENERAL COMMODITIES, including ARMORED CAR SERVICE D $275 GENERAL COMMODITIES, including D $100 GENERAL COMMODITIES, including ARMORED CAR SERVICE HAZARDOUS MATERIALS (Complete Supplementary Hazardous Materials Safety Suey) D $275 GENERAL COMMODITIES, including D $100 GENERAL COMMODITIES, including HAZARDOUS MATERIALS HAZARDOUS MATERIALS and (Complete Supplementary Hazardous Materials Safety ARMORED CAR SERVICE Survey) (Complete Supplementary Hazardous Materials Safety Suey) D $275 GENERAL COMMODITIES, INCLUDING HAZARDOUS MATERIALS and ARMORED CAR SERVICE (Complete Supplementary Hazardous Materials Safety Survey) MOTOR CARRIER IDENTIFICATION L egal Name (see definiti o n s pg. 1 ): A&A C A RRIER LL C ---- ---- --- ---- --- -- - Trade Name(s), dba(s), if any: - --- --- ---- -- -- -- -- - - Emai I address : AA DI S PATCH82@GM A IL. COM Phone Number : 206 -22 9- 5 66 9 Fax Number: - ---- --- ---- - Business (Mailing) Address : 1 9 20 1 108TH AVE SE STE 102 REN T ON, W A 9 80 55 Physical Address (if different): 1 822 1 168TH W AY SE REN T ON, W A 9 80 5 8 Unified Business Identifier Number (UB I): 60 4 - 33 5 -7 9 1 - - - - - - - - - - - - - - Check D if under 16,001 GVW 3193153 USDOT: --- -- --- - - OR 4-2017 Page 3 of 5 DOR- SOS- SAFER- UCR- INS- PAID-

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Page 1: A&A CARRIER ----LLC · UTILITIES AND TRANSPORTATION COMMISSION 1300 Evergreen Park Dr. SW, PO Box 47250, Olympia, WA 98504-7250 Telephone: (360) 664-1222 -Fax: (360) 586-1181-Email:

APPLICATION FOR PERMIT

Intrastate Common Carrier Operating Authority (excluding Household Goods)

WASHINGTON UTILITIES AND TRANSPORTATION COMMISSION 1300 S Evergreen Park Dr. SW, PO Box 47250, Olympia, WA 98504-7250

Telephone: (360) 664-1222 - Fax: (360) 586-1181- Email: [email protected]

FOR OFFICIAL USE ONLY Employee CC#

Reception Number Insurance Carrier ID#

111-0268-200-02'

-

TYPE OF APPLICATION

Defined in WAC 480-14-040

New Common Carrier Permit Authority, Extension of Common Carrier Permit Authority

.

or Transfer of Existing Permit Number

$275 GENERAL COMMODITIES ONLY D $100 GENERAL COMMODITIES, including

ARMORED CAR SERVICE

D $275 GENERAL COMMODITIES, including D $100 GENERAL COMMODITIES, including

ARMORED CAR SERVICE HAZARDOUS MATERIALS (Complete Supplementary Hazardous Materials Safety Survey)

D $275 GENERAL COMMODITIES, including D $100 GENERAL COMMODITIES, including

HAZARDOUS MATERIALS HAZARDOUS MATERIALS and (Complete Supplementary Hazardous Materials Safety ARMORED CAR SERVICE Survey) (Complete Supplementary Hazardous Materials

Safety Survey)

D $275 GENERAL COMMODITIES, INCLUDING

HAZARDOUS MATERIALS and

ARMORED CAR SERVICE (Complete Supplementary Hazardous Materials Safety Survey)

MOTOR CARRIER IDENTIFICATION

Legal Name (see definitions pg. 1): A&A CARRIER LLC ---------------------

Trade Name(s), dba(s), if any: ---------------------

Em a i I address: [email protected]

Phone Number: 206-229-5669 Fax Number: -------------

Business (Mailing) Address: 19201 108TH AVE SE STE 102 RENTON, WA 98055

Physical Address (if different): 18221 168TH WAY SE RENTON, WA 98058

Unified Business Identifier Number (UBI): 604-335-791----..--;�----------

Check D if under 16,001 GVW 3193153 USDOT: ---------- OR

4-2017Page 3 of 5

DOR-SOS-SAFER-UCR-INS-PAID-

Page 2: A&A CARRIER ----LLC · UTILITIES AND TRANSPORTATION COMMISSION 1300 Evergreen Park Dr. SW, PO Box 47250, Olympia, WA 98504-7250 Telephone: (360) 664-1222 -Fax: (360) 586-1181-Email:
Page 3: A&A CARRIER ----LLC · UTILITIES AND TRANSPORTATION COMMISSION 1300 Evergreen Park Dr. SW, PO Box 47250, Olympia, WA 98504-7250 Telephone: (360) 664-1222 -Fax: (360) 586-1181-Email: