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r o PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> RESIDENTIAL BUILDING PERMIT APPLICATION <br /> { Mailing Address:P.O. Box 547, Anacortes, WA 98221 <br /> cry <br /> \l'qw Office Location: 904 6111 Street,Anacortes WA 98821 <br /> Phone: (360) 293-1901, Fax: (360)293-1938 <br /> PLEASE REFER TO THE RESIDENTIAL BUILDING PERMIT CHECKLIST BELOW FOR SUBMITTAL REQUIREMENTS <br /> PROJECT ADDRESS(Street,Suite#): PARCEL(S)#: <br /> Subdivision/Lot#: PROJECT VALUATION: $ <br /> r3 tc c 2-Li (2 LDS 1 l -to 13 Iv??R.ox d, a o <br /> APPLICANT: Phone: <br /> Si' BIZ. J w 717 fc, U 9 41 - 1d 0 —► 1 <br /> Address(Street,City,State,Zip): L.9-0( q$'n-‘z,) E-Mail Address: <br /> • k Vs,C. -4.6 - is t-i" 44,4 csa t- r-o 5 2 r 41�,..-) ti 4 os'-- l c o w <br /> PROPERTY OWNER: ��`/ (L� k c C Phone: <br /> kaG -5.4 o q4 l -. 4.3-7 <br /> Address(Street,City,State,Zip): oI.Z/ E-Mail Address: <br /> 02_ .10C-�- Q.IIjG �jcw� G41vPhC <br /> CONTACT PERSON: Phone: <br /> R 0 Eft- S a a- <br /> Address(Street,City,State,Zip): E-Mail Address: <br /> LENDING AGENCY: Phone: <br /> Iv C, N>t_ l�I <br /> Address(Street,City,State,Zip): E-Mail Address: <br /> tJ/44, N/,4 <br /> CONTRACTOR:* Phone: <br /> C3 w N £.1L <br /> Address(Street,City, State,Zip): E-Mail Address: <br /> Professional License#: Exp.Date: <br /> *All Contractors&Subcontractors must have a valid City of Anacortes <br /> business license prior to doing work in the City. Contact the City's Business License#: Exp.Date: <br /> Finance Department at(360)299-1968. <br /> PROPOSED WORK: ,4"›a PxrE-Q l O R. c, R.S w I t., c,w f o <br /> K 1 S N s- '>E A c t-i-C 1> �.. A a_. .G '— <br /> I <br /> PROPOSED NEW SQUARE FOOTAGE: <br /> Basement SQ': 0 Finished Basement: ❑ Unfinished Basement <br /> 1st Floor SQ': Garage/Carport SQ': <br /> 2n 1 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. <br /> Print Name: IZ(SG > \' E w E TT Owner Er Agent ❑ (specify): <br /> Signature: ► Date: i v.).., ( y,'L e"(c� <br /> Page 1 of 3 <br />