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Y p PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> l r PLUMBING & MECHANICAL PERMIT APPLICATION <br /> VW Mailing Address:P.O. Box 547, Anacortes, WA 98221 <br /> ,cow 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 /> 4206A BLUE HERON CIRLCE P127934 $730 <br /> Subdivision/Lot#: RESIDENTIAL KI COMMERCIAL ❑ <br /> APPLICANT: Phone: <br /> BARRON HEATING 360-676-1131 <br /> Address(Street,City,State,Zip): Email Address: <br /> 5100 PACIFIC HWY#103, FERNDALE, WA 98248 LAINIEJ@BARRONHEATING.COM <br /> PROPERTY OWNER: Phone: <br /> MICHAEL PAINTER <br /> Address(Street,City,State,Zip): Email Address: <br /> 4206A BLUE HERON CIRCLE NA <br /> CONTACT PERSON: Phone: <br /> BARRON HEATING 360-676-1131 <br /> Address(Street,City,State,Zip): Email Address: <br /> 5100 PACIFIC HWY#103, FERNDALE, WA 98248 LAINIEJ@BARRONHEATING.COM <br /> CONTRACTOR:* Phone: <br /> BARRON HEATING 360-676-1131 <br /> Address(Street,City,State,Zip): Email Address: <br /> 5100 PACIFIC HWY#103, FERNDALE, WA 98248 LAINIEJ@BARRONHEATING.COM <br /> *All Contractors& subcontractors must have a valid City of Professional License#: Exp.Date: <br /> BARRO HA179D7 10/23/21 <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. 600-092-564 3/31/22 <br /> Is this work,associated with another project? Yes ❑ No 7 If yes, specify: <br /> PROPOSED WORK: Gas piping to BBQ <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: LAINIE JUHL Owner ❑ Agent IX (specify):BARRON HEATING <br /> Signature: �-�- Date: 4/19/21 <br />