HomeMy WebLinkAboutPermit File BLD-2021-0717 3912 R Avenue (5)PLANNING, COMMUNITY, & ECONOMIC DEVELOPMENT DEPARTMENT
RAF PERMIT APPLICATION
Mai ing Address: P. O. Box 547, Anacortes, WA 98221
Office Location: 904 61h Street, Anacortes WA 98821
Phone, (360) 2934901
PLEASE REFER TO THE RE -ROOF PERMIT CHECKLIST FOR SUBMITTAL REQUIREMENTS
e RESIDENTIAL ❑ COMMERCIAL
PROJECT ADDRESS (Street, Suite #): 3921 RAVE
PARCEL(s) #: P 58828
Subdivision/Lot #:
SEATTLE SYNDICATE TO ANA VAC W'LY 10' R AVE ADJ & 24 TO 26 BLK 8
PROJECT VALUATION $ 60,000.00
APPLICANT: Kenneth Van Gaasbeek
Phone. 360-708 4065
Address (Street, City, State, Zip):
1004 Commercial ave
Email Address:
ken@kensailing.com
PROPERTYOWNER' Kenneth Van Gaasbeek
Phone:360-708-4065
Address (Street, City, State, zip): 3912 R
Email Address:
ave
CONTACT PERSON: Kenneth Van Gaasbeek
Phone:
Address (Street, City, State, Zip):
Email Address:
3208 K ave anacortes wa 98221
CONTRACTOR:*
Phone:
Address (Street, City, State, Zip):
Email Address
Contractor's License #
Exp. Date:
*All Contractors & subcontractors must have a valid City of
Anacortes business license prior to doing work in the City.
Business License #:
Exp. Date:
Contact the City's Finance Department at (360) 2994968.
PROPOSED WORK Adjust roof line to remove the flat roof portion and reroof with metal roofing Q A Q 1' fi re
TYPE OF ROOFING: Metal
NUMBER OF LAYERS: 1
CLASS OF ROOFING: ❑ A ❑ B ❑ C
NUMBER OF
SQUARES: f gad $ �w (dte
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: Kenneth Van Gaasbeek
Owner a Other ❑ (specify):
Signature:
Date: 7/22/2021
Page 1 of 2
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