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G� PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT <br />PLUMBING & MECHANICAL PERMIT APPLICATION <br />Mailing Address: P.O. Box 547, Anacortes, WA 98221 <br />L 17 <br />V� Office Location: 904 0 Street, Anacortes WA 98821 <br />17_� Phone: (360) 293-1901, Fax: (360) 293-1938 <br />PLEASE REFER TO THE PLUMBING & MECHANICAL PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS <br />PROJECT ADDRESS (Street, Suite #): <br />Parcel(s) #: <br />Subdivision/Lot #: <br />Residential ❑ Commercial ❑ <br />APPLICANT: <br />Phone: <br />Fax: <br />Address (Street, City, State, Zip): <br />E-Mail Address: <br />PROPERTY OWNER: <br />Phone: <br />Fax: <br />Address (Street, City, State, Zip): <br />E-Mail Address: <br />CONTACT PERSON: <br />Phone: <br />Fax: <br />Address (Street, City, State, Zip): <br />E-Mail Address: <br />CONTRACTOR:* <br />Phone: <br />Fax: <br />Address (Street, City, State, Zip): <br />E-Mail Address <br />*All Contractors & subcontractors must have a valid City of <br />Anacortes business license prior to doing work in the City. <br />Contact the City's Finance Department at (360) 299-1968. <br />Contractor's License # <br />Exp. Date: <br />Business License #: <br />Exp. Date: <br />Is this work, associated with another project? Yes ❑ No ❑ If yes, specify: <br />PROPOSED WORK: <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 the City of Anacortes. <br />Print Name: Owner ❑ Agent ❑ (specify): <br />Signature: ^ Date: <br />