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GAS Y p PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> l r PLUMBING & MECHANICAL PERMIT APPLICATION <br /> ViAletW 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 /> 2517 17th St. P123579 4,023 <br /> Subdivision/Lot#: RESIDENTIAL 0 COMMERCIAL ❑ <br /> Lot 5,6,7, block 5 <br /> APPLICANT: Phone: <br /> Dori Vail 360-676-1131 ext 196 <br /> Address(Street,City,State,Zip): Email Address: <br /> 5100 Pacific Highway, Ferndale, WA 98248 doriv@barronheating.com <br /> PROPERTY OWNER: Phone: <br /> CHRISTENSEN PAMELA G 503-201-0717 <br /> Address(Street,City,State,Zip): Email Address: <br /> 2517 17th Street, Anacortes, WA 98221 <br /> CONTACT PERSON: Phone: <br /> Pamela Christensen 503-201-0717 <br /> Address(Street,City, State,Zip): Email Address: <br /> 2517 17th Street, Anacortes, WA 98221 <br /> CONTRACTOR:* Phone: <br /> Barron Heating 360-676-1131 ext 196 <br /> Address(Street,City,State,Zip): Email Address: <br /> 5100 Pacific Highway, Ferndale, WA 98248 doriv@barronheating.com <br /> *All Contractors& subcontractors must have a valid City of Professional License#: Exp.Date: <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. BARROHA179D7 10/23/2022 <br /> Is this work,associated with another project? Yes ❑ No ® If yes,specify: <br /> PROPOSED WORK: Gas stove installation <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: Dori Vail Owner ❑'Aggent ❑ (specify): Contractor <br /> Signature: Diu gad' <br /> Date: /2/3O/2O2-1 <br />