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� �� PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> Mailing Address:P.O. Box 547, Anacortes, WA 98221 <br /> Office Location:904 6th Street,Anacortes WA 98821 <br /> +q7 Phone: (360)299-1984 <br /> Clearing & Grading Permit Application <br /> FORM CG-1 : CLEARING & GRADING PERMIT APPLICATION <br /> 1. PROPERTY INFORMATION <br /> Project Address(Street,Suite#): Assessor Parcel Number: <br /> 0/ 0 ( )L, P 33 03a <br /> Subdivision/Lot#: Zoning Designation: Lot area(size): , S 9 Ac re r <br /> 2. PROJECT DESCRIPTION <br /> Project Summary: <br /> v -1 2 aQd ,1-0 e xrri-f r&c;d �cc_ <br /> Total area of land disturbance: 3, 3" sq. ft. <br /> Grading quantities: <br /> Imported material/fill cubic yards Source: <br /> Excavated material /cut (:) cubic yards Disposal site: Ga/e- I' ctA y <br /> Total: /'f 0 cubic yards s o? Jret►.e/ <br /> 3. PROPERTY OWNER INFORMATION <br /> Name: ay Etc // Phone: '6,0 C' ?U— W97 <br /> Address(Street,City,State,Zip): Email Address: / <br /> q2 o/ 0 /9ve /9nac - 1 d e: ('r.Mc cc_ t yvptofiX c-u 6-4A.._ <br /> 4. CONTRACTOR INFORMATION <br /> Name:* Phone: <br /> Contractors Business Licenses State License#: City License#: <br /> *Ail Contractors&Subcontractors must have a valid City <br /> of Anacortes business license prior to doing work in the Expiration Date: Expiration Date: <br /> City. <br /> Address(Street,City,State,Zip): Email Address: <br /> City Of Anacortes Clearing&Grading Permit Application <br /> Updated March 1,2021 Page 1 of 14 <br />