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INCERWM[i <br /> APR2 5 2019 <br /> cITY OF ANA7NWG, <br /> a COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> r ,PLUMBING & MECHANICAL PERMIT APPLICATION <br /> Mailing Address: P.O. Box 547, Anacortes, WA 98221 <br /> h Office Location: 904 6`h Street, Anacortes WA 98821 <br /> Phone: (360) 293-1901 <br /> PLEASE REFER TO THE PLUMBING&MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS <br /> PROJECT ADDRESS(Street,Suite#): PARCEL(S)#: PROJECT VALUATION: <br /> 2ioz 27t' 7/ <br /> Subdivision/Lot#: RESIDENTIAL I& COMMERCIAL ❑ <br /> APPLICANT, 1 Phone: 4 f [ -a <br /> DrJca �1 l c. Dom•/ 1 I �1 <br /> Address(Street, City,State,Zip): Email Address: <br /> 1 0 ' . aid` eL 1 r.l C.o,,I-L, Ef *v\- 0 ebe Eic.>. <br /> PROPERTY OWNER: Phone: <br /> 'APO l.,.J-e--1t ,"JAl— <br /> Address(Street,City,State,Zip): Email Address: <br /> )_ i ,- -)--el. �` p i a,‘-c- <br /> CONTACT PERSON: Phone: <br /> CZ DC, (,,- e_I I ;J s <br /> Address(Street,City,State,Zip):, Email Address: <br /> CONTRACTOR:* Phone: <br /> Address(Street, City,State,Zip): Email Address: <br /> al v' --Y"- P r c'- Ana,, r6 c)ti a1 I <br /> *All Contractors&subcontractors must have a valid City of Professional License#: Exp.Date: <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. 1,.7 7&:7 c_ iLD '..);J A-- <br /> Is this work, associated with another project? Yes E Now. If yes, specify: <br /> r <br /> PROPOSED WORK: 17, •'^P , i .-� �s t.I I Se -ti.n r'" +`' ' Jf - CA`1-`� <br /> 1.1.-• fill0 C- it\- I4. C" 0A {-,L^ �-(•\. ‘i - ark ._ tra....i•t, e.t.A........e <br /> 1 <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 peinuit <br /> application to the City of Anacortes. <br /> Print Name:"C D 0,4 `\‘J �C.� Owner Age7' ( <br /> t El (specify): <br /> Signature: c � Date: Li 1 / <br /> 6 <br />