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- & u - • \°\ - ( al 4 <br /> 7 ,� __�� 2O\ - O2as <br /> PLA fir_ & ECONOMIC DEVELOPMENT DEPARTMENT <br /> '"� '' \, CCESSORY DWELLING UNIT (ADU) ERMIT APPLICATION <br /> ddre . - Anacortes, WA 98221 <br /> -; Office Location: 904 6th Street, Anacortes WA 98821(ft y g Ul I f 1 <br /> Phone: (360) 299-1984, Fax: (360) 293-193,8 <br /> 0 APR 15 9919 LI <br /> PLEASE REFER TO THE ACCESSORY DWELLING UNIT PERMIT APPLICATION CHECKLIST >` <br /> THAT FOLLOWS FOR SUBMITTAL REQUIREMENTS Y OF ANACOR i Maw <br /> NEW CONSTRUCTION ❑ CONVERSION ❑ ADDITION <br /> ---))1(---AT-T-AC-14E-B- ��,W DETACHED <br /> HABITABLE FLOOR AREA OF ADU: <br /> PROJECT ADDRESS(Street,Suite#):10 1(0 01-14 J WP <br /> Subdivision/Lot#: PARCEL(S)#: 1 <br /> APPLICANT: p^�n sthq- Phone: <br /> 1 K (A. -43- \376 <br /> Address(Street City, State,Zip): E-Mail Address: <br /> 1 \-1T-14 SikEETQ' R 'el, rnrp b& C 1f - <br /> PROPERTYOWNER: t i Phone: 60_A613-1376 <br /> Address(Street, City, State,Zip): E-Mail Address: <br /> 10ISO —- <br /> - <br /> ti-Tip S ET l �C c . rnrpA4conit . ne�- <br /> CONT CT PERS N:PAQ A SUP- bhone: - 9.0k�` I 37(0 <br /> Address(Street, City, State,Zi E-Mail Address: <br /> 10 l(0 11-ri1 -i EFT L I Ic ornc-45-, (1&f <br /> PROPOSED WORK: ! f-- <br /> u Z/ e ?11' Pt . . ( tl , a r <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 peiinit <br /> application to the City of Anacortes. <br /> Print Name: U9.,1 X Owner ❑ Other <br /> Signature: ��// 1�/ Air/ Date: 1-1-15-R0 LC( <br /> Page 1 of 2 <br />