Laserfiche WebLink
EME <br /> IWIF <br /> E ,Y 17 2011 PL NNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> i <br /> 4, .J RESIDENTIAL BUILDING PERMIT APPLICATION <br /> 9116,�E,ANACORTES Mailing Address: P.O. Box 547, Anacortes, WA 98221 <br /> q `4 Office Location: 904 6th Street, Anacortes WA 98821 <br /> Phone: (360) 293-1901, Fax: (360) 293-1938 <br /> PLEASE REFER TO THE RESIDENTIAL BUILDING PERMIT CHECKLIST BELOW FOR SUBMITTAL REQUIREMENTS <br /> PROJECT ADDRESS(Street,Suite#): Parcel(s)#: <br /> NI, t—T ' ialt -TW-- 55L (Z-Si°tfi -000-01°1—ooaCp. <br /> Subdivision/Lot#: A„ Project Valuation: $ <br /> c , j� zcz �T lei k P K- wi <br /> APPLICANT,:,-7 C AN Phone:L 1 7�Z- Fax: <br /> Address(Street,City,State,Zip : E-Mail Address: 1 <br /> mv_ <br /> PROPER OWNER: Phone: Fax: <br /> Address(Street,City,State,Zip): E-Mail Address: <br /> mt <br /> CONT CT PERSON: Phone: Fax: <br /> TTAV42 )N /13 -7`fv2 <br /> A/refs/g- Cy�,State,Zip): n0v�� E MailAddress: <br /> LENDING AGENCY: `� Phone: Fax: <br /> FP-- <br /> Address(Street,City,State,Zip): E-Mail Address: <br /> CONTRACTOR:* Phone: Fax: <br /> rI J-�/c--5(/Q Z`l 3- 7)-f-P- <br /> Address(Street,City,State,Zip): E-Mail Address: <br /> / 9 J a t. 5r PKA t C4rJa,.flc be rb I (eJ Oame , --y <br /> Professional License#: xp.Date: <br /> *All Contractors&Subcontractors must have a valid City of Anacortes NA <br /> business license prior to doing work in the City. Contact the City's Business License#: Exp.Date: <br /> Finance Department at(360)299-1968. <br /> PROPOSED WORK: 5/yip.L.L, ATTV 1" (a(- `YO 1?-c )r2/Q c� <br /> 537 fct. f'r <br /> PROPOSED NEW SQUARE FOOTAGE: <br /> Basement SQ': 33 Finished Basement: ❑ Unfinished Basement <br /> 1st Floor SQ': S3 Garage/Carport SQ': 1,, —__- <br /> 2"d Floor SQ': t(7(..a--- ^� Deck/Covered Porch/Patio SQ': �/� <br /> Fire Sprinkler: Yes ❑ No L� Lot Area SQ': da) <br /> Is construction associated with an accessory dwelling unit? Yes ❑ No <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 t City of nacortes. F <br /> Print Name: C(-- ' CLY of �� Owner �f Agent ❑ (specify): <br /> Signature: tV 61...4 .eo_.a.___ E.0.111......., ,..--.:1-, Date: 7 & , ° / 7 <br /> Page 1 of 3 <br />