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Application_1331213CITY OF EDMONDS MyBuildingPermit.com Building Application #1331213 Applicant First Name Last Name Company Name ODILIO M MATA-CAMBRONERO Mata's Roofing, LLC Number Street Apartment or Suite Number E-mail Address 18921 8th Ave NE mataroof7@gmail.com City State Zip Phone Number Extension Shoreline WA 98155 (206) 446-9297 Contractor Company Name MATA'S ROOFING LLC Number Street Apartment or Suite Number 18921 8TH AVE NE City State Zip Phone Number Extension Shoreline WA 98155 (206)446-9297 State License Number License Expiration Date UBI # E-mail Address MATASRL776BP 1/17/2025 FD5DD7R7B mataroof7@gmail.com Project Location Number Street Floor Number Suite or Room Number 616 SUNSET AVE City Zip Code County Parcel Number EDMONDS 98020 00520100000100 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 Bryan D Dds Olson Number Street Apartment or Suite Number 616 SUNSET AVE N 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: 6/12/2023 Submitted By: ODILIO M MATA-CAMBRONERO Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Building Application #1331213 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. Page 2 of 2