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41I <br /> MECHANICAL PERMIT APPLICATION <br /> �`" Building Department <br /> . "m P.O. Box 547 Anacortes, WA 98221 <br /> � � Phone No.: 360-293-1901 FAX: 360.293.1938 <br /> SITE ADDRESS: .403 Vllhs v iGrGA) 3t.ai 1� <br /> CONTRACTOR <br /> Name Crt.tc* cSke.1e.-"Slnc.ALAVA k t'\\5, L c PROJECT DESCRIPTION <br /> �UU U.) CI New worts <br /> Address �tJ���U+\ <br /> Alteration <br /> City/State/Zip 1^t\T Lim r n o�� W 4?T 1 3 <br /> Phone 3(4L) 3 3c4 ).5 3 FAX 3 C%(7 I 1. (I 1 1( Permit Fee 23.50 <br /> State License# C cc+SI VI 0 0) I Exp '7 31 III Type of Equip. Fee Each No. Amount <br /> City of Anacortes Business License ffi Air Cond.Unit 10.65 <br /> PROPERTY OWNER Refrigeration Unit 10.65 <br /> Name At I(. BR ANT- Forced Air System 14.80 <br /> Address ? f!oE.3 W h•S Hticioro EL-06. Floor Furnace 14.80 <br /> City/State/Zip ,/1J*LOrfQ-. 5e tet, . Wall Heater 14.80 <br /> Phone SO v '2.3 C FAX Clothes Dryer 10.65 <br /> E-mail Address Ventilation Fan 7.25 <br /> APPLICANT Range Hood 10.65 <br /> Name S cars; Gas Fireplace 10.65 <br /> Address Gas Water Heater 10.65 <br /> City/State/Zip Gas Piping 4.75 <br /> Phone FAX Other(Describe) <br /> E-mail Address W Or9O'5r." /0•40r / /0.0"" <br /> CONTACT TOTAL FEES DUE 34,4 <br /> Name e.c\ 5 oL,s c1 <br /> Address S►OO LC) .v%%i c:r\ <br /> City/State/Zip T1k- Vex r r7:� LA.) <br /> Phone 3I0O 3 Lo J5 3 FAX 3(? `0 4 Si 7 q <br /> E-mail Address Crrc34c;i-LAt Swctis\ Cs s\ <br /> I HEREBY ACKNOWLEDGE I HAVEREAD THIS PERMIT APPLICATION AND STATE THE INFORMATION IS CORRECT,AND <br /> AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING ACTIVITIES COVERED BY THIS <br /> PERMIT APPLICATION. WIN THIS PERMIT ALL CONTRACTORS AND SUBCONTRACTORS SHLL HAVE A CURRENT <br /> WASHINGT•N STATE «•�RACTORS LICENSE AND A CITY BUSINESS UCENSE.STOP WORK ORDERS WILL BE <br /> ISSUED • ' OB SITES ERE CONTRACTORS/SUBCONTRACTORS ARE WORKING WITHOUT PROPER LICENSE. <br /> A•�,0-7- ANTS -IG ATURE ATE <br /> Last Updated 11-2905 <br />