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Y o PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT <br /> Al RE-ROOF PERMIT APPLICATION <br /> iw.. • <br /> Mailing Address:P.O. Box 547, Anacortes, WA 98221 <br /> 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- DUPLEX ❑ COMMERCIAL <br /> PROJECT ADDRESS(Street,Suite#): PARCEL(s)#: <br /> 2114-2116 21 st St, Anacortes, WA, 98221 P56173 <br /> Subdivision/Lot#: PROJECT VALUATION$ <br /> 15,915.00 <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 info@mtbakerroofing.com <br /> PROPERTY OWNER: Phone: <br /> Scott Nelson (Trustee) 360.708.4229 <br /> Address(Street, City, State,Zip): Email Address: <br /> 34 5 Cedar Glen Way, Anacortes, WA, 98221 scottay111@hotmail.com <br /> CONTACT PERSON: Phone: <br /> Address(Street,City,State,Zip): Email Address: <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 info@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 02/2023 <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: ® A ❑ B ❑ C NUMBER OF SQUARES:42 <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 Other ❑ (specify): Employee MBRI <br /> Signature: Emily King Date: 2.2.22 <br /> Page 1 of 2 <br />