HomeMy WebLinkAboutPermit File 5012 Macbeth Drive (2) • 0 '' City of Anacortes Invoice/Permit#: BLD-2019-0008
904 6th Street
Applied date: 01107/2019
P.O.Box 547`"
Issue date: 01/07/2019
`. " Anacortes, WA 98221-0547 Expire date: 07/05/2020
Job Address: 5012 MACBETH DR Permit Type: Reroof Single Family Residence
ANACORTES WA 98221-3028 Project:
APN: P59829
Remarks:
Owner: BRENT ADAMS Contractor: SKAGIT ROOFING LLC
Address: 5012 MACBETH DR Address: 9672 FARM TO MARKET RD
ANACORTES WA 98221-3028 BOW WA 98232-7223
Phone: Phone: (360)428-1900
License#:
General Information: Fees:
Occupancy Group it-1 Building Permit Fee 181.25
Building Valuation 9009 State Building Code Fee Resi 6.50
Total Calculated: 187.75
Deposits/Receipts: 0.00
Total Due: 187.75
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THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITI1TtJ 180 Qj4}-S„ F 'IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORIOS C0110/ME ICt DI�)
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALLPR'OVNIdIAS
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN O{l NOR; I11E
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STAT'E, R
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ..4:, C;1
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TURE OF OWNER OR AUTHORIZED AGENT I UED BY - c n to a-
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PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
RE-ROOF PERMIT APPLICATION
31 Mailing Address: P.O. Boa:547, Anacortes, WA 98221
'9 Office Location: 904 6th Street, Anacortes WA 98821
Phone: (360) 293-1901, Fax: (360) 293-1938
PLEASE REFER TO THE RE-ROOF PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
RESIDENTIAL 0 COMMERCIAL
PROJECT ADDRESS-(Street,Suite#): PRCEL-(-s)-#: - - - -
S O Vl C-3 E-rtl D R,
S�ii di iion/Lot#: PROJECT VALUATION$
4a0q 00
APPLICANT: Phone: 3 �2eL l l
Ss<�tCr,cT Rou,Fi rJ 4 L lL CL U d
Address(Street,City, State,Zip): E-Mail Address:
c (o 2 FA QM. Ti MRf_t Ad)
PROPERTY OWNER: 130,,,,, (,,,p Q�+2.31. Phone:
alt��.r A-DPt t S C-I(o (0 rt0— L-L2Yi 9
Address(Street,City,State,Zip): E-Mail Address:
5o i2 I4A-C- 3e-r i 02 A-rtnta✓+- s
CONTACT PERSON: Phone:
G(a t- S z 2 r
Address(Street,City,State,Zip): E-Mail Address:
g L Z 2 �h2 M -rr., ,F-A.t-2rLc T /t G t ,
CONTRACTOR:* Phone:
S KrcC��T Q. ci c- 4 _ p O I-4 2-e — l 4 U V
Address(Street,City,State,Zip): E-Mail Address
q . •- — 1A-2r-i R £3Gw
*All Contractors& subcontractors must have a valid City of Contractor's License# Exp.Date:
skis%40t/eL 4-1,q P L ��s — z�
Anacortes business license prior to doing work in the City. Business License#: Exp.Date:
Contact the City's Finance Department at(360)299-1968.
PROPOSED WORK: TE Ps 2 G F F T Co nip 12--cre,s ' . t Al s iu*-Lz- Su AIfh c_
Curpo s c N 2Cu•Cxtity
TYPE OF ROOFING: C ave°se r-4 ur.+ NUMBER OF LAYERS: /
CLASS OF ROOFING: CAA ❑ B ❑ C NUMBER OF SQUARES: 2 ti
I declare under penalty of perjury that the information I have provided on this form/application is true,correct,and
complete,and that I am the property owner or duly authorized agent of the property owner to submit a permit
application to the City of Anacortes.
Print Name:S,"0`^-e-s R• r' �'-� Owner 0 Other Cr3‹pecify):C.47.1
Signature: 2- ilt Date: £— -- 1 e
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