M-3-75.pdf7 m-
I:,,
V
'')
IMPORTANT! Press Firmly Wbile Writing ApplicatimzlPERMIT
Appant Fill
Building Relocation Permit Inside Heavy Linea
ya
(NUMBER M _ S
NEW SITE ADDRESS'.
•� A-
OWNER'S NAME
{,�,''
4
P?'
i
A LIN ADS
EDMONDS PRE -MOVE
INSPECTION
I PER.hiIT NO. Al
CITY & ZONE TEL. NO.
FIRE
'LONE I C2� 3
BLDG. PERMIT NO. y r
I FOR �
MOVING CONTRACTOR
AT NEWEW SITE
�-
MOVE CONTRACTOR'S INSURANCE COVERAGE
1
7
I
{.
STREETADDRESS '
NAME OF SURETY r
PROVIDING P.L. &
I —0 rO1-� , %A/-,
6� (, V 7
P.D. COVERAGE
i
;
CITY &' ZONE TEL, NO.
I
STREET ADDRESS
F
;'g- 71- F S`/ 2 /t/ 7 `O
CONTRACTOR'S
STATE CITY BUSINESS
CITY ZONE & S T E
/[ +�
�
LICENSE NO. O ` / L/I ENSE NO.
VALID INSURANCE POLICY CHEPKED BY: DATE
SITE DESCRIPTION
76
ADDRESS OF PRESENT BUILDING SITE
BUILDING DESCRIPTION
L- rnl Description of Present Bldg. site — (Show below or attach four copies)
DESCRIBE BASIC CONSTRUCTION & PRESENT USE iOF BUILD`ING/:: fit/
(((
OVERALL LENGTH OF BUILDING: 2� FT.
j
OF NEW SITE
ADDREF�
HEIGHT AS LOADED S ' WIDTH AOADED
IILDG. AREA
JSS
`BUILDING
FT. / FT.
I (/ 6R. FT.
Legal Description of New Bldg. ,Ifs — (Show below or attach four copies)
POLICE - i'T. AP VAL MOV' G ROUTE
DATE
,
may`
`�'-
U t
W
TIC `commence Moving : ............� :T(-:j.......................
TIYne to
MOVING ROUTE
M
`
�J
Time to Flnlsh oving. ..........................................................
1 s j / t /}' �/ 196 r " P -� r r FIRE DEPARTMENT CLEARANCE OF ROUTING DATE
Ik
�`b : I ,�
.�_ -��'
EDNGINEERING CLEARANCE );Aj G j
qA. M.�
CLEARED BY: RELOCATION
PowerCompany ❑........................................................................................ PERMIT
FEE $
TelephoneCompany ❑................................................................................
NAME OF OWNER OF PRESENT BUILDING SITE
ATTENTION:
47/4 O ALO-C ME ADDRESS THIS PERMIT
MAIL O HO
AUTHORIZES
ONLY THE
I hereby acknowledge that I have read this application; that RELOCATION
the information given is correct; and that I am the owner, a OF THE
duly licensed moving contractor, or the authorized agent of one BUILDING
of these. I agree to comply with city and state laws regulating NOTED
building relocation; and in doing this work, no person will be
employed in violation of the Labor Code, State of Washington
relating to Workmen's Compensation Insurance.
Signature of Owner, BUILDING
Contractor, or INSPECTION
Authorized Agent .-- ........ / ............._... DEPARTMENT
Pho
Signer's 1 �,� .• ...C�.. �.G.% rlr.�. None�tr..'l. V%r. CITY OF
Address .......p,J. EDMONDS
city.: f .. .. .................................. I................................... PR Salo?
Date? 7.......................................
RECEIPT No.
PERMIT APPROVAL
THIS PERMIT DOES NOT BECOME
VALID UNTIL SIGNED BY THE
BUILDING OFFICIAL OR HIS DEPU-
rY, THE FEES ARE PAID, AND RE-
OEIPT IS ACKNOWLEDGED IN THE
SPACE P%RROVjIDED
By...V:.."..` a/ ...............
Director's Signature
Date.........,..`....�.L�...75...................
DISTRIBUTION OF COPIES
WHITE — File (Bldg. Dept.)
YELLOW — Move Inspector
GREEN — Assessor
GOLDENROD — Police Dept.
PINK — Moving Contractor