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IMPORTANT! Press Firmly
Whyte Writing PPlication!
APplleant Fill
Building Relocation Permit Inside Heavy Lines
ht VF, IATE 'TIME
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0 F.R'S NAME OPN WBUILD IN47TE
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I EDMONDS PRE -MOVE
INSPECTION
PERMIT NO.
CITY S9'ATE TE NO.
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FIRE BLDG PERMIT NO. o,Cr'D� / L4
3 2 3 FORis
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-NE NEW BITE O •'•�
MOVIN CONTRACTOR _
MOVE CONTRACTOR'S INSURANCE COVERAGE
SURETY
BTREE AD t& 8 -
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NAME OF
P D�VCOVERAGE tilUe '�
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STATTRACTOR'e '. -•I
CITY, ZONE & ST^AT/E �3/ rt
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LICENSE NO. ..
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VAL INSURANCE POLICY CHECKED SY: DATE
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SITE DESCRIPTION
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ADDRESS PRESENT BUILDING SITQ-,ATTACHLEGA I.DESCRiPT[ON
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ILDING DESCRIPTION
BUILDING
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BASZC CO BTRUCTION &PRESENT USE OF BUILDING:
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DESCRIBE
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PHONE
ADDRESS (� � 1 i_ -y y,. �
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pyERALL LENGTH OF BUILDING: 60 ( I'T•
BLDG. AREA
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MOVING OUTE'1 t. U j n i t
Y T T V
HEIGHT AS LOADEDWIDTH A8 LOADED
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a FT. FT. i 60 BQ. Fr.
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POLICE DEPT. APPROVAL OF MOVING ROUTE
DATE
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.
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Time to Commenee Mov ....................... ................
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Q.a3..0.._...
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Time to sh MovinF:..............._... .............__
FIRE DEPARTMENT CLEARANCE OF ROUTING
DATE
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BY:
By:
ENGINEERING EARANCE
D E
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CLEARED X�
4NOHOMISHCOUNTY /�Q� Ion</ ��/ee
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KING COUNTY ' ` J fJ •/
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- Power CompnnY
RELOCATION RECEIPT NO.
PERMIT
Telephone Company
FEE t
OTHER
ATTENTION:
PERMIT APPROVAL
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GRsH P,t�n� �rat'Ey �-Z-o
THIS PERMIT
THIS PERMIT DOES NOT BECOME
�
AUTHORIZES
VALID UNTIL SIGNED BY THE
BUILDING OFFICIAL OR HIS DEPU-
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ONLY THE
TY� THE FEES ARE PAID, AND RE-
I hereby acknowledge that I have read this application; that
RELOCATION
CEIPT IS ACKNOWLEDGED IN THE
the information gtven Ss correct; and that I am the owner, a
OF THE
SPACE PROVIDED
duly licensed moving contractor, or the authorized agent of one
of these. I agree to comply with city and state laws regulating
building relocation; and in doing this work, no person will be
Washington
BUILDING
NOTED
'
employed In violation of the Labor Code, State of
I
gy-...IF"'.!!'1............. .. .. ... ....................
Building o(fiE,al'e nature
relating Workmenpensation In urs ce.
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.PflgnatHre OI Be,
COntr 6r, or
BUILDING
INSPECTION
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'�'t�t
Authorized Agent ............ .:�:.`........ ....... ......... .... ,.:...........
DEPARTMENT
Date........:.L.._...................-
Signer's Phone tGl
Address :7.321...L......1.J�`._........ No. _y�4,:T:`....3_/T.....
CITY OF
EDAYONDS
... ..!.
DISTRIBUTION OF COPIES
p.
City ............... ............ .-............ Stat. ..... ,!.'.._r!.`..._....._.....
771-3202
WHITE File (Bldg, etpt.)
.Sit.l..'.:4
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YELLOGREEN — Assessor
Date ....................... ......__.................,,......_............................_...
GOLDENROD — Police Dept.
PINK — Moving Contractor