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PLANNING,COMMUNITY. &ECONOMIC DEVELOPMENT DEPARTMENT <br /> `� r PLUMBING & MECHANICAL PERMIT APPLICATION <br /> Mailing Address:P.O. Box 547, Anacortes, WA 98221 <br /> .c0 Office Location: 904 6th Street, Anacortes WA 98821 <br /> Phone: (360)293-1901, Fax: (360)293-1938 <br /> PLEASE REFER TO THE PLUMBING&MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS <br /> PROJECT ADDRESS(Stye t,Suite# • Parcel(s)#: <br /> Subdivision/Lot#: <br /> (7 1 se Residential L Commercial ❑ <br /> APPLICANT: ! €„ Phone: Fax: <br /> Address(Street,City!State,Zip):, E-Mail Address: <br /> J 2 c y d5 '2 P A'f-/ 'trrt` is '4 {' or e cYv s' s..5-x., :-'- <br /> 3 % ';v _ -r <br /> PPERTY OWNER: , Phone: Fix: <br /> Adds(Street,City,State,Zip): _ E-Mail Address: <br /> CONTACT PERSON: Phone: Fax: <br /> Address(Street,City,State,Zip): E-Mail Address: <br /> CONTRACTOR:*` L j( , . r Phone: Fax: <br /> Address(Street,City,State,Zip): E-Mail Address <br /> Contractor's License# Exp.Date: <br /> *All Contractors&subcontractors must have a valid City of :- 614A- it_1 b- <br /> �a%f <br /> Anacortes business license prior to doing work in the City. Business License#: Exp.Date: <br /> Contact the City's Finance Department at(360)299-1968. oil 1-7 ,-i <br /> Is this work,associated with another project? Yes ❑ No b'.' If yes,specify: <br /> PROPOSED WORK: <br /> I declare under penalty of perjury that the information I have provided on this form/application is true,correct,and <br /> complete,and that I am the property owner or duly authorized agent of the property owner to submit a permit <br /> application to the Cityof 4nacortes. <br /> P <br /> Print Name: c Owner ❑ Agent s ecify): G' `"I ' <br /> Signature: ` �`(Date: °tll . <br />