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Application_2021-0770CITY OF EDMONDS MyBuildingPermit.com Building Application #973478 Applicant First Name Last Name Blake W Atwell Company Name Loberg Roofing.com, Inc. Number Street 5800 188th St SW Ste A Apartment or Suite Number E-mail Address blake@lobergroofing.com City State Zip Lynnwood WA 98037 Phone Number Extension (425) 2322419 Contractor Company Name LOBERG ROOFING.COM.INC Number Street 5800 188th St SW Ste A Apartment or Suite Number City State Zip Lynnwood WA 98037 Phone Number Extension (425) 775-2276 4252322419 State License Number License Expiration Date LOBERR*972K8 6/5/2023 UBI # E-mail Address RD998g1 1 R blake@lobergroofing.com Project Location Number Street 9210 SIERRA ST Floor Number Suite or Room Number City Zip Code EDMONDS 98020 County Parcel Number 00572800000900 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 Mack H Dubose Number Street 9210 SIERRA ST Apartment or Suite Number City State EDMONDS WA Zip 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: 6/7/2021 Submitted By: Blake W Atwell Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Building Application #973478 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