M-6-78.pdfIMPORTANT! Press Fi"nly While Writing Application!
Building Relocation
Applicajes
Permit Inside Hea��!f
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�?��� NUMBER {N�1
DWNER'S NAME
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W SITE ADDRESS
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MAILING ADDRESS
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PRE -MOVE ���... ttf Q
E MONDSINSPECTION t
I INSPECTION ! C /
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CITY & 'LONE
TEL. NO.
PERhfIT NO. / D' lJ p
RBLDG. PERMIT NO.!!l���---���/7�3 FOR WORK- /\/ (}')fOVING
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ONTRACTOR
AT NEW
Ujl'MOVE CONTRACTOR'S INSURANCE COVERAGETR
E ADDRESS
AME OP'SVRETYOVIDING P.L. &.D.
COVERAGE
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STATE CONTRACTOR'S 2(01 CIT BUSINESS
LICENSE NO. 2-2 5 ^Jj ,Z,.- LICENSE NO.
SITE DESCRIPTION
ADDRESS OF PRESENT BUILDING SITE
Legal Description of Present Isidg. Site — (Show below or attach four
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ADDRESS OF NEW BUILDING SITE
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Leval Ile—rintion of New Bide. Site — (ShoW below or attach four c(
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Power Company ❑ ......
Telephone Company ❑
NAME OF OWNER OF PRESENT BUILDING SITE
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MAIL OR HOME ADDRESS
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I hereby acknowledge that I have read this application; that
the information given is correct; and that I am the owner, a
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
employed in violation of the Labor Code, State of Washington
relating to Workmen's Compensation Insurance.
Signature of Owner,
Contractor, or
Authorized Agent ....... ....
Signer's 16? i ?� Phone
Address .............�...... kQ21E' No. ...................
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City ...Sf''`}.%.../.�3--.x-WS.� (............ .!..r-3.3..........
46
Date.. ..^... . .... ..... ..".................................................
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BUILDING DESCRIPTION
DESCRIBE BASIC CONSTRUCTION & PRESENT USE. OF BUILDING:
OVERALL LENGTH OF BUILDING: i,! S FT.
]EIGHT AS LOADED I WIDTH AS LOADED, I BLDG. AREA
FT.
I /.r v SQ. FT.
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FT. l.-� ,f7
POLICE DtPT.
kPPROVALF MOVING ROUTE
DATE
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Time to Commence
Moving: .....:...............................................-
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Time to Finish
.
Moving: ...................................................................
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FIRE DEPARTMENT CLEARANCE OF ROUTING
DATE
ATTENTION:
THIS PERMIT
AUTHORIZES
ONLY THE
RELOCATION
OF THE
BUILDING
NOTED
BUILDING
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
. /111.d% 0( (i
RECEIPT
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PERMIT APPROVAL
THIS PERMIT DOES NOT BECOME
VALID UNTIL SIGNED BY THE
BUILDING OFFICIAL OR HIS DEPU-
TY, THE FEES ARE PAID, AND RE-
CEIPT IS ACKNOWLEDGED IN THE
SPACE PROVIDED
.
BYe ............
D i ^/rveto r's^S/i�gnatu re
Date.....f V ""—L .......................... ..............................
DISTRIBUTION OF COPIES
WHITE — File (Bldg. Dept.)
YELLOW — Move Inspector
GREEN — Assessor
GOLDENROD — Police Dept.
PINK — Moving Contractor