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.,S1 Y 0 PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
<br /> Apie
<br /> i PLUMBING & MECHANICAL PERMIT APPLICATION
<br /> Mailing Address:P.O. Box 547, Anacortes, WA 98221
<br /> \7"kriPrs f';'
<br /> 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 /> 1 ciV 5 /0 -117 sr-I., P 56059 1 ff, q 72 ig-7
<br /> Subdivision/Lot#:
<br /> RESIDENTIAL ‘131 COMMERCIAL El
<br /> APPLICANT: Phone:
<br /> FOSS i-tEA 774/6 :Val Cd oi-i 416 (.366)3) --15/7
<br /> Address(Street,City,State,Zip): Email Address:
<br /> :33? E. se iiit(eu,(4, (0, S're"A frir, V61,445.4/;1,1,74- y3;17) 0,-dep;c9fasi-fiecL:4,1.7. co„.2
<br /> PROPERTY OWNER: Phone:
<br /> i , ,c 6/4 L TA Z 4 R ( 3 p D)2 7 3 - 5n it
<br /> Address(Street,City,State,Zip): Email Address:
<br /> po Gox 7 22- ,it A/44oz rt;--3- km 7322-1
<br /> —
<br /> CONTACT PERSON: Phod:
<br /> /VP/ (1')Viii:5-e.c (360).13‘— /5 i 7
<br /> Address(Street,City,State,Zip): Email Address:
<br /> 33 3 lE.6i-414'80W RA Sre. A lilr,V.6g/vezpi. WA (4.2-7 3 otele;,5 0-1-85-c 6 cali--7, co;41
<br /> CONTRACTOR:* Phone:
<br /> .. -.-E A l'PLI ci vr
<br /> Address(Street,City, State,Zip): Email Address:
<br /> Professional License#: Exp.Date:
<br /> *All Contractors& subcontractors must have a valid City of F055' 1-1-c" II/V z2--
<br /> Anacortes business license prior to doing work in the City.
<br /> Business License#: Exp.Date:
<br /> Contact the City's Finance Department at(360)299-1968. °o 2-2 3t 0 3 i
<br /> Is this work,associated with another project? Yes D No Z If yes,specify:
<br /> PROPOSED WORK: A 01-46r: 11 rFiA r ev/d fl `i,I,iril 1-11;6--: 1A, k r j mp lot_v.i ,,,ii 41 (OWL Er?",
<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: Att/P4-F147 ,j_ iltifia-24. Owner 0 Agent FC] (specify): 1-.2),$;f#4477/4/d.
<br /> Signature: 4010 drair -- Date: IV 3 61-2(
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