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1 I <br /> III <br /> PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> RE-ROOF PERMIT APPLICATION <br /> Mailing Address:P.O. Box 547, Anacortes, WA 98221 <br /> Office Location: 904 6th Street, Anacortes WA 98821 <br /> Phone: (360) 293-1901, Fax: (360) 293-1938 <br /> PLEASE REFER TO THE RE-ROOF PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS <br /> RESIDENTIAL ❑ COMMERCIAL <br /> PROJECT ADDRES (Street,Suite#): PARCEL(s)#: <br /> CO l l -1k ,1'4'1`eet— 3 8/2-OOS-002-O©Of <br /> Subdivision/Lot#: PROJECT VALUATION$ <br /> APPLICANT• Phone:c ce, v in � (f—Pc , s1z 3tca )4 6// <br /> G. i ge8 f <br /> Address(Street,City,State, ip): X E-Mail Address: <br /> g,1- 5 g G f"7 yAn c w l? S /jL� <br /> PRO ERTY OWNER: of "9,,��( Phone: <br /> 5.11.41 L ou,iS rAct vLej ll -8'. (-137 <br /> Address(Street,City,State Zip): E-Mail Addre : <br /> 5D/ irr red ra TerAa ) whisk-. corn <br /> CONTACT PERSON: Phone: <br /> v <br /> Address Street,City,State,Zip): / E-Mail Address: <br /> CONTRACTOR:*.8A- �- -/e ms e w Y e yc� `�Ovf/eai <br /> 9s a g phone: <br /> Address(Street,City,State,Zip): E-Mail Address <br /> Contractor's License# Exp.Date; <br /> *All Contractors&subcontractors must have a valid City of -c,/✓C.�iS cC/Zzot3. j 5 //j /o1- aw <br /> Anacortes business license prior to doing work in the City. Business License#: Exp.Date: <br /> Contact the City's Finance Department at(360)299-1968. _ I C, S /`/ / <br /> PROPOSED WORK: /2>©(, 0 C,. / (-)/7 e $ 3 r-, t CO. <br /> TYPE OF ROOFING: NUMBER OF LAYERS: <br /> CLASS OF ROOFING: ❑ A ❑ B ❑ C NUMBER OF SQUARES: <br /> I declare under penalty of perjury that the information I have provided on this foiin/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 0 Other ❑ (specify): <br /> Signature: :Irate: <br /> Page 1 of 2 <br />