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IF-0(8 f <br /> sateaovi,iv :lc, <br /> /-7 y PLANNING. COMMLNITY, & ECONOMIC DEVELOPMENT DEPARTMFNT <br /> r.1 _ <br /> z inr 1 RESIDENTIAL BUILDING PERMIT APPLICATION <br /> Mailing Address: P.O. Box 547, Anacortes. giA 98221 <br /> P'0 3 4°11 Lin-1) Office Location: h 904 6 Street, Anacortes WA 98821 <br /> Phone: (360) 293-1901, Fax: (360) 293-1938 <br /> PLE.4SE REFER TO THE RESIDENTIAL BUILDING PERAIIT CHECKLIST BELOW FOR SUBMITTAL REQUIREMENTS <br /> PROJECT ADDRESS(Street,Suite#): PARCEL(S)#: <br /> t 310 11 54-• <br /> Subdivision/Lot A: PROJECT VALUATION: S <br /> 6/4) 1 lb <br /> APPLICANT. Phone: <br /> Address(Street.City.State.Zip): E-Mail Address: <br /> 4.3 S . )r Awl',co.-1-05( t4 822-1 <br /> PROPERTY OWNER: Pho?[6:: <br /> v 5,4t vt 6111 iitier -So c-- <br /> Address(Street.City.State.Zip): E-Mail Address: <br /> Tt"'`' 4-• A....4,r, w A 9462.2.1 <br /> CONTACT PERSON: Phone: <br /> S.1:14,440CA\ 3 too-7043 t <br /> Address(Street,rity,State,Zip): E-Mail Address: <br /> 41101 • A1.01.-15 D r. 4014(.0 t4) 9627-k 1?:>sinortwe-i1C-IP.A4 I,.ce) <br /> LENDING AGENCY: Phont: <br /> I Address(Street.City,State.Zip): E-Mail Address: <br /> CON RACTOR:'' Phone: <br /> t C. 4-n.c.1.2.0") /.1.4 &54tuut-i 1 36o - o8 (27.8 <br /> Address(Street,Mty,State,Zip): E-Mail Address: <br /> .1301 64 *1•141 Z,e• 41.14 tor.te t^.,1A 98121 (?).1k eio:, (. <br /> Pro essional License 4; Exp.Da <br /> *All Contractors&Subcontractors must have a valid City of Anacortes z,AEG‘e cf..853 m5 .1%,l - <br /> business license prior to doing work in the City. Contact the City's 7 <br /> Business License 4‘: Exp.Date: <br /> Finance Department at(360)299-1968. <br /> , lo01 61-0 5-7 -.tut 2o lei <br /> PROPOSED WORK: Va....e.vvi ova,t ca-P 4 ,A e "....4,te.e ro <br /> PROPOSED NEV SQUARE FOOTAGE: <br /> Basement SQ': iJ A • Finished Basement: D Unfinished Basement <br /> 1 Floor SQ': NI A Garage/Carport SQ': At(A, <br /> 2 Floor SQ': Af A Deck/Covered Porch/Patio SQ.: Al/A <br /> Fire Sprinkler: 0 Yes U No Lot Area SQ': A)(A <br /> 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: PC Ic• Owner 0 Agent ck(specify): Coe% cjv r <br /> Signature: Date: 7/2-it/ g <br /> Page lof 3 <br />