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`.v t 0PLANNING,COMMUNITY,&ECONOMIC DEVELOPMENT DEPARTMENT <br /> `' '' HOME OCCUPATION PERMIT APPLICATION <br /> Mailing Address:P.O. Box 547.Anacortes, WA 98221 <br /> ';t c ` Office Location: 904 611'Street,Anacortes WA 98821 <br /> Phone: (360)299-1984 <br /> PLEASE REFER TO THE HOME OCCUPATION PERMIT APPLICATION CHECKLIST <br /> THAT FOLLOWS FOR SUBMITTAL REQUIREMENTS <br /> ❑ NEW CONSTRUCTION ❑ ADDITION ❑ CONVERSION NO CONSTRUCTION PROPOSED <br /> 0 ATTACHED ❑ DETACHED . N/A <br /> FLOOR AREA OFHOUSE: I FLOOR AREA OF BUSINESS(<25%of House SQ') <br /> PROJECT ADDRESS(Street,Suite#): <br /> Subdivision/Lot It: PARCEL(S)#: <br /> APPLICANT: Phone: <br /> "T0. .IA G c0.x./ - CR.oo\''S'--. et.\(-: S0.7 • '3l'7 . 2349 <br /> Address(Street.City,State,Zip): Email Address: <br /> LOkO D . N�• F acac e.S , t1j t ct Z2\ 4-av�•.NMn1•t\\earA-trl(a cl,Ma��• 0t"^ <br /> PROPERTY OWNER: Phone: J <br /> \naW n k.a.wA tA.xi-%X !$,R. rill D • r7 9 2,n <br /> Address(Street,City,State,Zip): t Email Address: <br /> x <br /> CONTACT PERSON: _I Phone: <br /> Address(Street,City,State,Zip): I Email Address: <br /> X <br /> DESCRIPTION OF PROPOSED BUSINESS: C04,4, A ei rine X <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 /> 1- Print Name: 3 W/I 141'\f 0. 8 tJ AVM/ Jk Owner ❑ Other <br /> e�i'4. Signature:i % t- l✓( '`'I -77Date: S-2 g - 2 I <br /> Page 1 of 2 <br />