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At, Re-Roof Building Permit Application <br /> . , „ City of Anacortes Building Department <br /> 40010 P.O. Box 547 Anacortes,WA 98221 <br /> Phone No.: 360.293-1901 FAX: 360.293.1938 <br /> Type of Permit (check one) ❑ Residential ❑Commercial <br /> • <br /> Project Address: Zs{?1'> I`1 e€$- Parcel ID# <br /> Owner: c 3'F" 1 tl t6� PVt`� ✓11 I Ph__ Phone Number: i t. -79 9 <br /> Address: 2-1/4-1`-1 qq— l c City: t 2C-0 State:f e) Zip CodeR g22. <br /> Contractor: 5�(T Phone Number: <br /> Address: City: State: Zip Code: <br /> Contractor's License Number: Expiration: <br /> Type of Roofing: Number of Layers: ( Number of Squares: 3-2 <br /> Class of Roofing: ❑A ❑ B IC Installing,or replacing sheeting: ' e S <br /> Work Scheduled to Begin: Work Scheduled to End: <br /> The following is required for NON-Residential Buildings: <br /> ❑ All Non-Residential projects will require a site visit prior to the issuance of the permit for <br /> obvious signs of fatigue, condition of existing roofing and number of existing layers. <br /> ❑ Two copies of the installation specifications and U.L. listed roof assembly. <br /> ❑ Building square footage: <br /> ❑ Occupancy Group Office Retail <br /> Church Restaurant <br /> School <br /> Project Valuation: $ Cot 5 00 <br /> I hereby certify the above information is correct and that the construction on, and the occupancy and the use of <br /> the above described property will be accordance with the laws, rules and regulations of the State of <br /> Washington. The applicant will be responsible for providing a method of safely accessing roof for inspection. A <br /> final inspection and approval shall be obtained when the re-roofing is complete.AL-714- l ��-t 9rf <br /> 1V1o9 <br /> Applicants Sig ture Date <br /> Revised September 11,2008 <br />