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` PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> PLUMBING & MECHANICAL PERMIT APPLICATION <br /> ?41 ►4 Mailing Address: P.O. Box 547, Anacortes, WA 98221 <br /> o‘t~ 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 /> Subdivision/Lot#: RESIDENTIAL ❑ COMMERCIAL ❑ <br /> APPL ANT: <br /> �� • <br /> Imo! COuNt y �� �� Pho eL <br /> �w � LL6 `fze7f'3 <br /> Address S eet City,State,Zip,), Email Address: <br /> /orb 6""Mte/(A) —WiJO I <br /> PROPERTYt.J o ER e 2,' ,j Phone: T /e a 3 T 3 7 S �u <br /> AddreAddress(S�eq,Cii,Late Zip):j Email Address: <br /> CONTACT PERSON: Phone: <br /> Address(Street, City, State,Zip): Email Address: <br /> CONTRACTOR:* Phone: <br /> ft 'AA CAner <br /> Address(Street, City, State,Zip): Email Address: <br /> *All Contractors& subcontractors must have a valid City of Professiep8l n e p Exp.Date: <br /> Anacortes business license prior to doing work in the City. usi � a M� 7,4 Z' <br /> Busipe�se#: Exp.Date: <br /> Contact the CiO's Finance Department at(360)299-1968. Y <br /> Is this work, associated with another �'project? Yes El No <br /> No ❑ IIf yes, specify: <br /> �/ <br /> PROPOSED WORK: / ", �/1 I s Nh �' u <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 er r duly authorized agent of the property owner to submit a permit <br /> application to the Ci Anacort . <br /> Print Name: I e ` �'� Owner ❑ Agent ❑ (specify): <br /> Signature: Date: `7 . <br />