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[it <br /> 1, SEP 14 2U1B 11 , <br /> CITY OF ANACORTES <br /> PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> Cr '`' FIRE ALARM PERMIT APPLICATION <br /> r Mailing Address:P.O. Box 547, Anacortes, WA 98221 <br /> `l44' Office Location: 904 6`" Street,Anacortes WA 98821 <br /> ssicoVt`. Phone: (360) 293 1901, Fax (360)293-1938 <br /> PLEASE REFER TO THE FIRE ALARM PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS <br /> g MODIFY EXISTING SYSTEM ❑ INSTALL NEW SYSTEM <br /> X0 COMMERCIAL ❑ RESIDENTIAL <br /> PROJECT ADDRESS(Street,Suite#): PARCEL(S)#: <br /> 1/O S- 2 y tt\- 54-r.,--3- <br /> PRO CT VALUATION: <br /> -v►ti.C6t-`1- {-J ct/ 7 r Zz i J, 5—0c,,ro e <br /> APPLICANT: Phone: <br /> S co k,l� /-/zs- 3/7- 'zsy <br /> Address(Street,City,State,Zip): E-Mail Address: <br /> 30/1/ /4y7� A-ae_ ;Li�c� Or,- g8Zv/ 1;ofsc,. 0. co,1Isec.c,o,'�..cowl <br /> PROPERTY OWNER: Phone: <br /> 2O& F 1'4 , r_i 1-1-, eS.- fl 0 Cae_C.e.JLJ- 3C0- Z9.r-317'/ <br /> Address(Stree ,City, State,Zip): -+ E-Mail Address: <br /> llc9S Z7rk- S--r �-V�A_Gc9�44,2 L.JG..1 9g2Z( <br /> CONTACT PERSON: Phone: <br /> 5e-c,,C 9 Cc-,.5t C/z S-3t7—S_S`� <br /> Address(Street,City,State,Zip): E-Mail Address: <br /> '30i'/ / y1'� l_ Slik JF LA)C,. 95'2c)/ 14oI5e,.g L(50_,,,.c „,... (O4,-„. <br /> CONTRACTOR:* Phone: <br /> S -co ce--615-7 4/2S 3)7-52 C-5 <br /> Address(Street City State,Zip): E-Mail Address <br /> 3c-)!I/ / vy`Aii g4At oc,. ` Qz / 'Kc)i%.,e cc,.(( c.3 ,c_D <br /> *All Contractors&subcontractors must have a valid City of Contractor's License# Exp.Date: <br /> Anacortes business license prior to doing work in the City. Contact S �C� 9n y Z7'Wier <br /> Business License#: Exp.Date: <br /> the City's Finance Department at(360)299-1968. 60 <br /> I_97/— ©) <br /> Is this work,associated with another project? Yes 0 Nii's,fg, If yes, specify: <br /> PRO' iSED WORK: JLQQ 3 DE9c9r.(l40(CL i v gc�S,�' �,.t:I60o"c eu-� <br /> A- 4/ i)©c9' 14-0(9-e - l 9�e$+ ,r,.i t t� GHQ T �L st 0 <br /> 'Ott l-- re_ .4-(c-t..�.L Sys wt, J` <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 toiity of Anacortes. <br /> nacortes. <br /> Print Name: - d LSD Owner Agent ❑ (specify): <br /> Signature: Date: ,f-a- 2Q(e <br /> Page 1 of 2 <br /> Lh — 2O & <br />