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1T Y Q PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> PLUMBING & MECHANICAL PERMIT APPLICATION <br /> Mailing Address: P.O. Box 547,Anacortes, WA 98221 <br /> 4 " Office Location: 904 6th 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 /> I I ► . -"v" t U c r- R -' g) ctr c.S <br /> Subdivision/Lot#: RESIDENTIAL ):A COMMERCIAL ❑ <br /> APPLICANT: p-nCI.cor+e5 Phone: <br /> RrSoni ) cJoS cS 1DBP }Fli,e,mb1(75 3690-29 - jaGSJ <br /> Address(Street,City, State,Zip): Email Address: <br /> �n Ct Co(+eS P% to r o ce 1/43C*166 ee m <br /> PROPERTY OWNER: 1 �� � 2Phone: <br /> O <br /> Ri\�'1 c,r c{ c� "' <br /> Address(Street,City,State,Zip): Email Address: <br /> 63 it 7/ i !lv€ N FAarySiril1 GWA- V,PS hbar-1/4-®er cttl core , <br /> CONTACT PERSON: t'g 3 .240 Phone: <br /> Address(Street,City,State,Zip): Email Address: <br /> CONTRACTOR:* Phone: <br /> P�2r�o�s korflisP SS ��P : Ar cork-eauml S( o- 299 S2C)S" - <br /> Address(Street,City,State,Zip : Email Address: <br /> 615. CO • (b)(e1► d th\ WOO()w i , c 1 <br /> Professional License#: Exp.Date: <br /> *All Contractors&subcontractors must have a valid City of Kt]haw 8 21 tg ou Rig 1262a <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. (Q04 221 S 13 `so/ 20 20 <br /> Is this work, associated with another project? Yes ❑ No If yes,specify: <br /> PROPOSED WORK: eel6 Crg O3-e.( 11eo- .Cs, LL .tom i r1&Sfin j P r c( . <br /> No .ir} Cn ns resacfxA- car0,6r� t old n►tS cam/ now - <br /> 3 <br /> 60 CCua n GC(s f <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. <br /> frnaentX eci �`Print Name: Hann Owner 0 A sr <br /> g ( P fy):1�l�Am'c n P in, <br /> Signa Date: o l0 f 17 ! 20Iq <br />