Laserfiche WebLink
11 y 0 PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> � . RESIDENTIAL BUILDING PERMIT APPLICATION <br /> 1 7 :� Mailing Address: P.O. Box 547, Anacortes, WA 98221 <br /> 'IN Office Location: 904 6th Street, Anacortes WA 98821 <br /> Phone: (360) 293-1901 <br /> PLEASE REFER TO THE RESIDENTIAL BUILDING PERMIT CHECKLIST BELOW FOR SUBMITTAL REQUIREMENTS <br /> I <br /> PROJECT ADDRESS(Street,Suite#): PARCEL(S)#: 1 <br /> Subdivision/Lot#: PROJECT VALUATION: $ <br /> APPLI T: Phone: <br /> =-,5 th-M)K., 617 2a/d/i 3G 0 3-Sio .3 ycrg <br /> Addres 4reet,City, State,Zip): Email Address: <br /> ^mot . "Pork,'-*' <br /> PROPERTY OW4R: Phone: <br /> k?t(11 e <br /> Address(Street,City, State,Zip): Email Address: <br /> CONTACT PERSON: Phone: <br /> Address(Street,City,State,Zip): Email Address: <br /> LENDING AGENCY: Phone: <br /> Address(Street,City, State,Zip): Email Address: <br /> CONTRACTOR:* Phone: <br /> Stye a 5 a 6ov-t.. <br /> Address(Street,City, tate,Zip): Email Address: <br /> Pro sional License#: E Date: <br /> *All Contractors&Subcontractors must have a valid City of <br /> Anacortes business license prior to doing work in the City. Contact Business i se#: Exp.Date. <br /> the City's Finance Department at(360)299-1968. N. <br /> PROPOSED WORK: <br /> PROPOSED NEW SQUARE FOOTAGE: <br /> Basement SQ': ❑ Finished Basement: ❑ Unfinished Basement <br /> 1'`Floor SQ': Garage/Carport SQ': <br /> 2nd Floor SQ': Deck/Covered Porch/Patio SQ': <br /> Fire Sprinkler: ❑ Yes ❑ No Lot Area SQ': <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 City of Anacortes.c` A <br /> Print Name: /� J �rl2I1/�� Owner ❑ Agent 0 (specify): <br /> Signature: 79- 'v 4n\519 4020(et Date: <br /> Page 1 of 5 <br />