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Application_1210308CITY OF EDMONDS MyBuildingPermit.com Building Application #1210308 Applicant First Name Last Name Company Name Ana Bernal PNW ROOFING &CRAWL SPACE Number Street Apartment or Suite Number E-mail Address 12522 8th Ave W Apt C105 Pnwroofinginsulation@gmail.com City State Zip Phone Number Extension Everett WA 98204 (425) 321-8078 Contractor Company Name PNW ROOFING & CRL SPC INS LLC Number Street Apartment or Suite Number PO BOX 14338 City State Zip Phone Number Extension MILL CREEK WA 98082 4253218078 State License Number License Expiration Date UBI # E-mail Address PNWRORC825D6 3/31/2024 Rn491gssq Pnwroofinginsulation@gmail.com Project Location Number Street Floor Number Suite or Room Number 24130 FIRDALE AVE City Zip Code County Parcel Number EDMONDS 98020 27033600401600 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 Czarina A & Jesus L Francisco Number Street Apartment or Suite Number 24130 FIRDALE AVE City State Zip EDMONDS WA 98020 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: 10/3/2022 Submitted By: Ana Bernal Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Building Application #1210308 Project Type Single Family Residential Project Details Increasing Building Height? Activity Type Scope of Work Re -Roof Replacement - Roofing Only Residence The height of the building is not increasing. Page 2 of 2