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135 2ND AVE N (2).pdf
IMPORTANT! Press Fsrsily While Writing Application! "' "2 604L Building Relocation Permit InSide Heavy �" MOVE DATE TIME _ a;-�3 9 L-Z)1*1 NUMBER M OWNERB NAME OF NF.W BUILDING SITE NEW SITE ADDRESS - ATTACH LEGAL DESCRIVRON Ruben and Laura Wilson G - w MA3LING ADDRE88 101 F.W. 171St St. "�'I" , E3NSPECTI MOV PECTION PERMITNO. FIRE BLDG. PERMIT NO. ZONE 3 z a ANEW SITE CITY STATE TEL. NO. Seattle, Wa. 98177 ( 542-1711 MOVING CONTRACTOR J.W. Dent MOVE CONTRACTOR'S INSURANnC1ES COVERAGE STREET ADDRESS NAME OF SURETY tt't� /I[„�. 1. /t%✓5�71 /K(! �' PROVIDING PROVIDING P.L. & �(/}}�� P.D. COVERAGE/��.(' Z TEL, NO, CITY STATE Seattle, WA. ( 763-9271 / CI�� CONTRACTOR'S LICENSE NO. N. JW-DEDi-BA2 233-1t3 D INSURANCE TOLICY ECEED BY: DATE I a SITE DESCRIPTION ADDRESS OF PRESENT BUILDING SITE ATTACH LEGAL DESCRIPTION BUILDING DESCRIPTION f M 135 2nd N In o O (7 NAME OFO ER 672-31 DESCRIBE BASIC CONSTRUCTION & PRESENT USE OF BUILDING: 6 i:a tcr. `<olviJ: i+lood 'brickframeDw�li;na _K ADDR SINE 2�� 2 �dlnondS OVERALL LENGTH OF BUILDING: 551 I FT. BLDG. AREA MOVING ROUTE �t2 L4 l Au •!' - jed U - D,* HEIGHT AS LOADED wZDTH AS LOADED Fm. 3 6" FT. 47 Ba. FT. ( Z r = J/r' AP A OF MOVIN BOB DATE � 4R tlg So - 5`tRF& �y /D POLICE % gz�sj � "�4. r � O;„�7 --• , '• �� By: i I i Mn�Ins:..._�...........r....ar,*.�s..._...._........._ e T D �° ^vt L, ' n On d%1 .` TIS T-" 5*Y i� aCie. ° �GU Qf m In Gnmmen�e ' Time m Fmlxh Mov�nR: .. - .... .;2J.- - ROUTING Him fD � �I G�� a.Gy.. li ,G IJ L2 F+ LLJJ FIRE DEPARTMENT CLEARANCE OF DATE O r - 9 ai By;-, DATE CL LEARANCE Z / ((f ' RING COUNT / —t -- Power CompnnY ��Q� LOCATION RECEIPT 10. PERMIT S D / _YY - Telephone Cnmpnny(m —1d -'t OTHER c ATTENTION: PERMIT APPROVAL _ vl THIS PERMIT THIS PERMIT DOES NOT BECOME - Z AUTHORIZES VALID UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS DEPU- O �( ONLY THE TY, THE FEES ARE PAID, AND AE- 0 I hereby acknowledge that I have read this application; that RELOCATION CEIPT IS ACKNOWLEDGED IN HE M the information given is correct; and that I am the owner, a OF THE SPACE PR,, IDE duly licensed moving contractor, or the authorized agent of one of these. Z agree t0 comply with city and state laws regulating thts wilt be BUILDING NOTED building relocation; and in doing work, no person In violation of the Labor Code, State of Washington By�,,,; .............._...L....... ..................... employed retating to Workmen's Compensation Insurance. foDr wnO , SD,OgnntBrtauCrteO INSPECO rO. J//'/1 Authorized Agent.Z ....C..�.../....B..m../M...i.n./.e..o..t.R./c/.1// T DEPARTMENT .s... ..n..n_w..re.............._ Date 4r'/'�)//L// Signer's 1�t �i?�// CITY OF Address /j EDMONDS DISTRIBUTION OF COPSES State 771-3202 WHITE — File (Bldg. Dept.) eity1.LJ�/.q.............. YELLOW — Move Inspector GREEN — Assessor — Police Dept. Data ........c.r.........._......................................................... GOLDENROD PINK — Moving Contractor Building Moving Application �tivYla>7t(s Location:,?��d T1s/! Sid/ Date: ��. Name of Mover: kreSAddress: G J,7 / 7✓L/YJ6-v Proposed Route oft�tovement: (stare Highway, County Roads, Cary srreets) Q ._o ,nF _ /J,t..,r),.- n.nf4V//tC /'O.,<r�r cfi� OtOa/V"d/YlCci(�() Starting Point: (mite posit Destination: (mile posit Type of Building:z�.t� lNo. Stories: No. Rooms:s, Construction: 14ftr/t (Frame,arick,etc) Roo :off: on: Maximum Width:95,/, Maximum Height & Length: (Loaded) 0©. cw, v uc7 Estimated Wt. of Building:,'5fr) C Tons. Amt. Insurance Carried: /11 I ifL Z71� , f Have you made arrangements for moving overhead wires, signals, signs, etc. GAY, ! Date of Movement: P Starting time: I -y �v� Licensed C//ap: _Truck Plate No: �� Dollie Plate Nos. a 'Nel Will front of building be carried on towing vehicle ooroilieess? Name of Escort you will use: i �%� V / T)°/�)V < `!{rQ 419. 4 aIM-z, Are escort personnel properly licensed? �C .S CGt},u/ �vJ(� K) Owner of building o� Address: X52 — I, the applicant named below, certify that the information given herewith is true and correct and that I will follo�n—the requirements of a Special Per it, if issued. � Signature of Applicant e./ J z O n m 0 �m mo OA C mZ C.H : o -n m� m oIn� r mN D z i rn z 0 n m