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PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> RE-ROOF PERMIT APPLICATION <br /> 74' ‹ Mailing Address: P.O. Box 547, Anacortes, WA 98221 <br /> Office Location: 904 61 Street, Anacortes WA 98821 <br /> Phone: (360) 293-1901 <br /> PLEASE REFER TO THE RE-ROOF PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS <br /> 21 RESIDENTIAL ❑ COMMERCIAL <br /> PROJECT ADDRESS(Street,Suite#): PARCEL(s)#: <br /> 2102 10TH ST P56208 <br /> Subdivision/Lot#: PROJECT VALUATION$ <br /> 14,244 <br /> APPLICANT: Phone: <br /> Mt Baker Roofing (Katy Mount) 360-733-0191 <br /> Address(Street, City, State,Zip): Email Address: <br /> 3945 Home Rd, Bellingham WA 98226 katymount@mtbakerroofing.com <br /> PROPERTY OWNER: Phone: <br /> KEN IRELAND 619.254.6879 <br /> Address(Street,City, State,Zip): Email Address: <br /> 254 D AVE CORONADO CA 98118 KIRELAND@SAN.RR.COM <br /> CONTACT PERSON: Phone: <br /> KEN IRELAND 619.254.6879 <br /> Address(Street,City, State,Zip): Email Address: <br /> KIRELAND@SAN.RR.COM <br /> CONTRACTOR:* Phone: <br /> Mt Baker Roofing, INC 360-733-0191 <br /> Address(Street, City, State,Zip): Email Address <br /> 3945 Home Rd, Bellingham WA 98226 katymount@mtbakerroofing.com <br /> Contractor's License# Exp.Date: <br /> *All Contractors& subcontractors must have a valid City of MTBAKR1055ML 05/2020 <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. 601526326 001 0001 2-29-20 <br /> PROPOSED WORK: To remove current roofing and replace with one layer of roofing <br /> TYPE OF ROOFING:COMPOSISTION NUMBER OF LAYERS:3 <br /> CLASS OF ROOFING: gi A ❑ B ❑ C NUMBER OF SQUARES:22 <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: Katy Mount Owner ❑ Other ❑ (specify): <br /> Signature: Ket,fy1 Date: 4.22.20 <br /> Page 1 of 2 <br />