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/S'T Y o'' PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
<br /> r , PLUMBING & MECHANICAL PERMIT APPLICATION
<br /> 7 ,' Mailing Address:P.O. Box 547, Anacortes, WA 98221
<br /> Office Location: 904 6`h 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#): P RCEL(S)#: PROJECT VALUATION:
<br /> 190). (1 1'Vi - 'e •\12-• !3, .
<br /> Subdivision/Lot� t ,� #: RESIDENTIAL V COMMERCIAL ❑
<br /> APPLICANT: Phone:
<br /> VitinVi 1-160(161 ?)U6- Wu 1t31 'C,ul 11-4 -
<br /> Address(Street,City,State,Zip): ',.1` Email Address:.
<br /> l() VCafA(1L1 V1,�C1�!(�lll01 ' ,€ Y1c1 . , VA-ufa,t 11�.-v-tc- 0(i1�i�l lYwhi(i1 . ANI
<br /> PROPERTY OWNER: ) 4 Phone: �, )
<br /> Cl e.1Pcs(c 'Wt\56r l..Q&• 2-02, (�-1•U3
<br /> Address(Street,City,State,Zip): Email Address:
<br /> CO�'x) 11°,'V1 `-st'Y1- Foactoat , w(Y 6tS2�� erc 1r( .:.1�1l�tSl ul nctat: r1�1-
<br /> NTACT PERSON: Phone J
<br /> I\,u..�1�i ('-11�.t )L 2i Oft (12110 R,3\ luri
<br /> Address(Street,City,State,Zip): Email Address:
<br /> q►4(m n�,( 1e1f..tni lll1«Y�IJI 16 ULJ � j Y Aiv�,�L.;�c.0 toattybY\Vllea tY,a (KIWI
<br /> CONTRACTOR1.* J • " Phone: ,.�'° �✓
<br /> �n on )(no-Am ` QO' (i2-1 • 1N lift
<br /> Address(Street,City,State,Zip): \...1 Email Address: .
<br /> *All Contractors&subcd at actors fnust have a valid City of Professional License#: Exp.Date: "
<br /> Anacortes business license prior to doing work in the City. C� 1���� � �� 10115122. ate
<br /> Contact the City's Finance Department at(360)299-1968. Business License#: Exp.Date:
<br /> IuGO Oct,." off 1U. .
<br /> )7s .
<br /> Is this work,associated with another project? Yes ElNo ® If yes, specify:
<br /> PROPOSED WORK: InctrA1 jr)6 l\l`(1.t11e I�I1IYIAP, 1 1,611�J �. a.inAtt3W (A)Itli1 2L)/t d1I�
<br /> j
<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: kt 10,(A (I/LQ k. Owner ❑ Agent +4 (specify): Raw. tie/Wiry
<br /> Signature: k. .it—I.,—,,..- (./�./ -- --- - - Date: IA I RIt A ,!
<br /> �U a
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