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PLANNING, COMITY, & ECONOMIC DEVELOPMENT DEPARTMENT <br />RESIDENTIAL BUILDING PERMIT APPLICATION <br />MailingAuuress: P.O. Box 541, Anacortes, WA 98221 <br />Office Location: 904 &' Street, Anacortes WA 98821 <br />Phone: (360) 2934901, Fax: (360) 2934938 JUN 2 2018 <br />PLEASE REFER TO THE RESIDENTIAL BUILDING PER 47T CHECKLIST BELOW FOR SUBMITTAL REQUIREMENTS <br />PROJECT ADDRESS (Street, Suite #): <br />PARCEL(S) #: <br />Subdivision/Lot#: <br />PROJECT VALUATION: S <br />APPLICANT: <br />Phone: <br />Address (Street, City, State, Zip): <br />&Mail Address: <br />PROPERTY OWNER: <br />Phony <br />Address (Street, City, State, Zip): <br />� <br />E-Mail Address: <br />i t l a; s (C V,- <br />, �,,,A <br />e. ehh <br />CONTACT PERSON: <br />Phone: r <br />t ,cam. � 1 <br />St�.A <br />Address (Street, City, State, Zip): <br />E-Mail Address: <br />_ P f"\ <br />LENDING AGENCY: <br />Phone: <br />t3 <br />Address (Street, City, State, Zip): <br />&Mail Address: <br />CONTRACTOR:* <br />Phone: <br />�4 <br />Address (Street, City, State, Zip): <br />E-Mail Address: <br />*All Contractors &Subcontractors must have a valid City of Anacortes <br />Professional License #: <br />Exp. Date: <br />business license prior to doing work in the City. Contact the City's <br />Finance Department at (360) 2994968. <br />Business License #: <br />Exp. Date: <br />PROPOSED WORK: A L ;4 <br />, v � 6 LA �cb EWA i (7 1 P � 6s _� � U f � � <br />PROPOSED <br />NENN <br />SQ1JARE FOOTAGE: <br />Basement SQ': r- <br />❑ Finished Basement: Unfinished Basement <br />V Floor SQ': <br />Garage /Carport SQ': ' <br />2" d Floor SQ': <br />Deck/ Covered Porch/ PatioSQ': <br />* <br />Fire Sprinkler: ElYes' ❑ No <br />Lot Area SQ': <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 <br />duly authorized agent of the property owner to submit a permit <br />application to the City of Anacortes. <br />Print Nam 5%OW . _ . E <br />Owner Agent ❑ specify): <br />Signature: <br />t9v <br />Page 1 of 3 <br />