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G� ' o PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> RE-ROOF PERMIT APPLICATION <br /> k\tr47. Mailing Address:P.O. Box 547, Anacortes, WA 98221 <br /> cow Office Location: 904 6th Street, Anacortes WA 98821 <br /> Phone: (360) 293-1901 <br /> PLEASE REFER TO THE RE-ROOF PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS <br /> 0 RESIDENTIAL ❑ COMMERCIAL <br /> PROJECT ADDRESS(Street,Suite#): PARCEL(s)#: <br /> 1916 24th St, Anacortes, WA, 98221 P57609 <br /> Subdivision/Lot#: PROJECT VALUATION$ <br /> $12,804.50 <br /> APPLICANT: Phone: <br /> Mt. Baker Roofing Inc 360.733.0191 <br /> Address(Street,City, State,Zip): Email Address: <br /> PO Box 31100, Bellingham, WA, 98228 emilyking@mtbakerroofing.com <br /> PROPERTY OWNER: Phone: <br /> James Ebersole <br /> Address(Street, City,.State,Zip): Email Address: <br /> same as project address <br /> CONTACT PERSON: Phone: <br /> David Ebersole 360.672.0984 <br /> Address(Street,City,State,Zip): Email Address: <br /> daebersole@me.com <br /> CONTRACTOR:* Phone: <br /> Mt. Baker Roofing Inc 360.733.0191 <br /> Address(Street,City, State,Zip): Email Address <br /> PO Box 31100, Bellingham, WA, 98228 emilyking@mtbakerroofing.com <br /> Contractor's License# Exp.Date: <br /> *All Contractors& subcontractors must have a valid City of MTBAKR1055ML 05/2022 <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 02/2022 <br /> PROPOSED WORK: Remove current roofing and replace with 1 layer of new roofing <br /> TYPE OF ROOFING:Composition NUMBER OF LAYERS:2 <br /> CLASS OF ROOFING: O A ❑ B ❑ C NUMBER OF SQUARES:34 <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: Emily King Owner 0 Other ❑ (specify): Employee MBRI <br /> Signature: Emily King Date: 5.21.21 <br /> Page 1 of 2 <br />