HomeMy WebLinkAboutPermit File BLD-2019-0166 3905 S Avenue X City of Anacortes Invoice/Permit#: BLD-2019-0166
904 6th Street
Applied date: 03/27/2019
'"" " !' P.O.Box 547 Issue date: 03/27/2019
t�► Anacortes, WA 98221-0547
'.4'° ''qt Expire date: 09/22/2020
Job Address: 3905 SAVE Permit Type: Reroof Single Family Residence
ANACORTES WA 98221-3646 Project:
APN: P96112
Remarks: Reroof single family residence
Owner: WILLIAM TURNER Contractor:
Address: PO BOX 1534 Address:
ANACORTES WA 98221
Phone: Phone:
License#:
General Information: Fees:
Building Valuation 11600 Building Permit Fee 209.25
State Building Code Fee Resi 6.50
Total Calculated: 215.75
Deposits/Receipts: 0.00
Total Due: 215.75
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THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OT, R STATE OR
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNA RE OF OWNER OR AUTHORIZED AGENT ISS E BY L "+�
(I __ 7- -2__ CP\ — \ ci
,z Y o PLANNING, COMMUNITY, &ECONOMIC DEVELOPMENT DEPARTMENT
`' .0 RE-ROOF PERMIT APPLICATION
Mailing Address:P.O. Box 547, Anacortes, WA 98221
'Oq �`; 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 At COMMERCIAL 0
PROJECT ADDRESS(St eet,Suite#): PARCEL(s)#:
3Subdivision/Lot#: �� PROJECT VALUATION$
1/, 6aeo —
APPLICANT: Phone: Fax:
S k.4 -y et . 60 g.). lg"O
Address(Street,City,State,Zip): E-Mail Address:
PROPERTY OWNER: Phone: Fax:
Sit ( Ti v-a.,,tr-- 3 bo-770-5-0 T7
Address(Street,City,State,Zip): E-Mail Address:
1qo e-ve., . A444 4'W A
CONTACT PERSON: Phone: Fax:
3I1t )- h-.k.: .3 a 33
Address(Street,City,State,Zip): E-Mail Address:
3/7 S 6, .%; %.a- k-at: 3 ?4', ,.%) tJA 1 P133
CONTRACTOR:* Phone: Fax:
Address(Street,City,State,Zip): E-Mail Address
*All Contractors&subcontractors must have a valid City of Contractor's License# Exp.Date:
S t4-6 it ALIF
Anacortes business license prior to doing work in the City. Business License y Q i Exp.'Dat : C1
Contact the City's Finance Department at(360)299-1968.
PROPOSED WORK: e en a V e, o /
v- c w,. "Pi 410 4 4 ifR'e '
TYPE OF ROOFING: esow a NUMBER OF LAYERS:
CLASS OF ROOFING: DI A 0 B 0 C NUMBER OF SQUARES: 3 Z-
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: t< ( I t-k.2 Owner 0 Agent ❑ (specify):
Signature: t Date —-37.2-9-/-4—
Page 1 of 2
fi ,4„;-_ Cityof Anacortes
Invoice/Permit#: BLD-2019-0166
904 6th Street
Applied date: 03/27/2019
P.O.Box 547 Issue date: 03/27/2019
34`•; 0 Anacortes, WA 98221-0547
Expire date: 09/22/2020
Job Address: 3905 S AVE Permit Type: Reroof Single Family Residence
ANACORTES WA 98221-3646 Project:
APN: P96112
Remarks: Reroof single family residence
Owner: WILLIAM TURNER Contractor:
Address: PO BOX 1534 Address:
ANACORTES WA 98221
Phone: Phone:
License#:
General Information: Fees:
Building Valuation 11600 Building Permit Fee 209.25
State Building Code Fee Resi 6.50
Total Calculated: 215.75
Deposits/Receipts: 215.75
Total Due: 0.00
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I
HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS
OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR
LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY