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1, , 2 0 /,r , 01q, <br />PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT <br />r` <br />PLUMBING & MECHANICAL PERMIT APPLICATION <br />i Mailing Address: P.O. Box 547, Anacortes, WA 98221 <br />`;� Office Location: 904 61h Street Anacortes WA 98821 <br />�'�co�i Phone: (360) 293-1901, Fax: (360) 293-1938 <br />MAR 16 2a�� <br />PLEASE REFER TO THE PLUMBING &MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQ UIREMENTS <br />reet, Suite #): <br />PRZOZ4!! ' T OM <br />Parcel(s) #: F9L* 19 <br />STO <br />Subdivision/Lot #: <br />Residential ❑ Commercial IRL <br />APPLICANT: <br />Phone: <br />6 <br />Fax: <br />1; ;L 1\J4 r <br />Wle.3.79) <br />Address (Street, City, State, Zip): <br />E-Mail Address: <br />22v1 U — l <br />/i'L WRRII ®L FINC . Go&4 <br />PROPERTY OWNER: - <br />Phone: <br />Fax: <br />97 ES_ llac�r <br />Address <br />s Street, City, S ate, Zip): <br />E-Mail Address: <br />00 1v <br />C`O�NTAC�'T5PR�SO� <br />Phone: <br />Fax: <br />J� <br />,3i <br />A res (of <br />Street, City, State, Zip): <br />E-Mail Address: <br />1 51 <br />��M ®C� Yoy-A�-1► ems' <br />CON CSAR• * <br />9� L kJOL, 1 <br />Phone: <br />� 733.Igi � <br />Fax: <br />Address (Street, City, State, Zip): <br />E-M it Address - <br />C7(i�- ��U <br />l��'[,Re""C• a <br />*All Contractors &subcontractors must have a valid City of <br />Cotractor's License <br />al w f t�'7� <br />ED t <br />x e: <br />Anacortes business license prior to doing work in the City. <br />Business License #: <br />Exp. ate: <br />Contact the City's Finance Department at (360) 2994968. <br />Is this work, associated with another project? Yes/l3- No <br />❑ If yes, specify: (Ic1 (q,,j OF&A J <br />PROPOSED WORK: <br />v✓ <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 <br />agent of the property owner to submit a permit <br />application to the City of Anacortes. <br />�I <br />Print Name: VL<!f <br />Owner ❑ Agent A specify): _ <br />Signature <br />Date: <br />