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G� PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> Ao RE-ROOF PERMIT APPLICATION <br /> c• 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 /> 811 22nd St P58077 <br /> Subdivision/Lot#: PROJECT VALUATION$ <br /> 5 14,003.00 <br /> APPLICANT: Phone: <br /> Valentine Roofing / Courtney Wright 206-575-7656 <br /> Address(Street, City,State,Zip): Email Address: <br /> 400 Industry Dr#130 Tukwila, WA 98188 projectengineers@valentineroof.com <br /> PROPERTY OWNER: Phone: <br /> Greg Nadal <br /> Address(Street, City, State,Zip): Email Address: <br /> 811 22nd St, Anacortes, WA 98221 <br /> CONTACT PERSON: Phone: <br /> Courtney Wright 206-400-7121 <br /> Address(Street,City,State,Zip): Email Address: <br /> 400 Industry Dr#130 Tukwila, WA 98188 projectengineers(c�valentineroof.com <br /> CONTRACTOR:* Phone: <br /> Valentine Roofing 206-575-7656 <br /> Address(Street, Cit , State Zip): Email Address <br /> 400 Industry Dr#130 Tukwila, WA 98188 projectengineers@valentineroof.com <br /> Contractor's License# Exp. Date: <br /> *All Contractors& subcontractors must have a valid City of VALENRI927J8 4/28/2022 <br /> Anacortes business license prior to doing work in the City. Business License#: EEx Date: <br /> Contact the City's Finance Department at(360)299-1968. VALENRI927J8 4/281%22 <br /> PROPOSED WORK: We are removing the current composition shingle and single ply roofing material.We will be replacing at least 11 squares <br /> of sheeting and with 1/2"Cdx plywood.We will then be install new composition shingles and new single ply PVC material. <br /> TYPE OF ROOFING:Comp/ PVC NUMBER OF LAYERS: 1 <br /> CLASS OF ROOFING: EADB ❑ C NUMBER OF SQUARES:13 <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: Courtney Wright � ) // Owner ❑ Other (specify): Rep <br /> Signature: ett 24- aAGnu.�� Date: 12/7/2021 <br /> Page 1 of 2 <br />