Application_2021-1085CITY OF EDMONDS MyBuildingPermit.com
Building Application #1001773
Applicant
First Name Last Name
Ann Dvorak
Company Name
Valentine Roofing Inc.
Number Street
400 Industry Drive
Apartment or Suite Number E-mail Address
#130 ann@valentineroof.com
City State Zip
Tukwila WA 98188
Phone Number Extension
2065757656
Contractor
Company Name
VALENTINE ROOFING INC
Number Street
400 Industry Drive
Apartment or Suite Number
#130
City State Zip
Tukwila WA 98188
Phone Number Extension
2064007151
State License Number License Expiration Date
VALENR1927J8 4/28/2022
UBI # E-mail Address
RD9R1g179 ann@valentineroof.com
Project Location
Number Street
23632 101 ST AVE W
Floor Number Suite or Room Number
City Zip Code
EDMONDS 98020
County Parcel Number
00446700000500
Associated Building Permit Number
Tenant Name
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
Gary G Sayers
Number Street
23632 101 ST AVE W
Apartment or Suite Number
City State
EDMONDS WA
Zip
98020-5775
Certification Statement - The applicant states:
I certify that I am the owner of this property or the owner's authorized agent, including an appropriately licensed contractor. I have furnished true and
correct information. I will comply with all provisions of law and ordinances governing this type of construction work, whether specific herein or not. By
submitting this application I give the jurisdiction permission to enter the property to perform inspections. I understand that failure to comply with the above
may result in revocation of the permit.
Date Submitted: 8/5/2021 Submitted By: Ann Dvorak
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CITY OF EDMONDS MyBuildingPermit.com
Building Application #1001773
Project Type
Single Family Residential
Project Details
Increasing Building Height?
Activity Type Scope of Work
Re -Roof Replacement - Roofing & Sheathing Residence
The height of the building is not increasing.
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