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Permit_1257313CITY OF EDMONDS Building Permit My6uildingPermitxom Permit Information Permit Number RI n7n7'i_nnR4 Issued Date 1/20/2023 Expiration Date 7/19/2023 Job Address 23923 104TH AVE W Fee Paid $146.50 EDMONDS, 98020 Order Confirmation 1198530 Floor Related Permit# Suite Application ID 1257313 Contact Information Contact Name Ethel Moons Contractor Haider Construction Phone Number 4257713515 LNI License# HAIDEC*914DB Property Owner Tom J & Ethel B Moons Address 23923 104TH AVE W EDMONDS, Phone# 4257713515 WA City Bus. License # 602903374 Property Owner Phone Tenant Name Job Description A (Single Family Residential) (Re -Roof Replacement - Roofing Only) Residence project involving ( The height of the building is not increasing.) Conditions - Post Permit on site. Do not cover until inspected. Do not start any work until the preconstruction meeting is completed. 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. Applicant: Ethel Moons Page 1 of 2 t °F EDAf 0 1893 CITY OF EDMONDS Building Permit My6uildingPermitxom Permit Information Permit Number RI n9n9*i-n 1R'i Issued Date 1/20/2023 Expiration Date 7/19/2023 Job Address 23923 104TH AVE W Fee Paid $146.50 EDMONDS, 98020 Order Confirmation 1198530 Floor Related Permit# Suite Application ID 1257313 Inspections Inspection IVR Inspector Date Inspection IVR Inspector Date Tear Off or Sheathing Building Final Inspection Scheduling The issuance of this permit in no way constitutes approval from any other agencies having regulatory authority over the facility and this construction activity. It is the responsibility of the property owner to obtain any and all such required approvals. Page 2 of 2