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M4-76.pdf
j / F 1 r v/ IMPORTANT! Press Firmly While Writing Application! i Building Rel®cati®n Permit Applicant Fill Inside Heavy Lines r L PERMIT An` 11�-,'IF NUMBER LYL OWN S NAME NEW SITE ADDRESS R VE 84 RI? t SOA/ 3 2-O SUrvscr- Ave, Ci M a�v� MAILING NG ADDRESS I q7 S j =r RUE. EDMONDS PRE-MOV INSPECTION a CITY & ZONE TEL. NO. PERMIT NO. C_UM ONns �V U 1 Q I �� FIRE 1 2 ZONE MIT NO. FOR WORK MOVING CONTRACTOR �^ V©� ,T AT NEW SITE FOr�Li r FQ OM i�.U7 L Fr- MOVE CONTRACTOR'S INSURANCE COVERAGE STR - Err ADD ES l) A./rr A l44% � NAME OF SURETY PROVIDING P.L. & P.D. COVERAGE CITY & ZONE L. �� /� t STREET ADDRESS s°,N0. CN4,0AJPS / ! CONTRACTOR'S CITY, ZONE & STATE STATE I CITY BUSINESS LICENSE NO. LICENSE NO. VALID INSURANCE POLICY CHECKED BY: DATE SITE DESCRIPTION ADDRESS OF PRESENT BUILDING SITE BUILDING DESCRIPTION " Legal Descriptlon•of Present Bldg.to — (Show or a lath four copies) . DESCRIBE BASIC CONSTRUCTION & PRESENT USE OF BUILDING: 413twwulsh �[nwyp of S"ci< OVERALL LENGTH OF BUILDING: ADDRESS OF NEW BUILDING SITE HEIGHT AS LOADED WIDTH AS LOADED BLDG. AREA 3��j V AveM li/I� FT. G. FT. I L SQ. FT. Legal Description of New Bldg. Site — (Show liel6w or attach four copies) POLICEOo,11U,6 OF MO NG ROUTE DATE y: w Time to Commence Moving: r __ ........ _.i ..... j MOVING ROUTE r,3d /� Time to Finish Moving: ......._ -7 G� / ... ... . ...... ...: .!.l.G. �....... ... A'�'ye !� FIRE DEPARTMENT CLE ANCE OF TING DATE 1� /�C,aNG Z Ave m r-6mom-9t S'i �� By: J FROM S/ ENG E ETNG 01Y RANCH— DATE A1 C—DMOa1OS .. D_&coAi kL-cey f , C CLEARED Y: Power Company ElRELOC ............. .................. ......_.._.._........................................ RELOCATION � � RECEIPT N`O�. FEE $ o{ _ Telephone Company ❑..........._................................................................... �. NAME OF OWNER OI' PRESENT BUILDING SITE ATTENTION: PERMIT APPROVAL MAIL OR HOME ADDRESS THIS PERMIT THIS PERMIT DOES NOT BECOME AUTHORIZES VALID UNTIL SIGNED BY THE ONLY THE BUILDING OFFICIAL OR HIS DEPU- I hereby acknowledge that I have read this application; that RELOCATION THE FEES ARE PAID, TY, AND RE - CEIPT IS ACKNOWLEDGED IN THE P the information given is Correct; and that I am the owner, a � OF THE SPACE PROVIDED 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 �G By "" '""""" ..'-""""-"-"""'--....""' relatingto Workmen's Compensation Insurance. P Director's Signature 1 Signature of Owner Contractor, or �/] BUILDING INSPECTION ` /�^ Authorized Agent ........................... .. GZ I !rLsf .._............_.. DEPARTMENT /YJ [��� Date ............................................K='•+' =............. SIgner's -{{- q Phone�f %` %%� .�Ny�8p CITY OF Address ........................ %�..!......kvcc ... No....$"T.S�V.7..1.'X:�t._ EDMONDS J / DISTRIBUTION OF COPIES y' City .....L+ili�i Gt �aO.S..............................................................._....... YR o-uo WHITE — File (Bldg. Dept.) /' Date t %..�--....... YELLOW — Move Inspector GREEN — Assessor .......�J.<vM.....�.v..... GOLDENROD — Police Dept. PINK — Moving Contractor t