M-8-78.pdfIMPORTANT! Press Firinly
Applicant Fill
Relocation Permit Inside Heavy Lines
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TEL. NO.
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STREET ADDRESS i
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TEL. NO.
CONTRACTOR'S / l-y(/;�i -- , STATE
CIT
LICENSE NO. .A'! �l S L�-�
( LICENSES NO.88
SITE DESCRIPTION DESCRIPTION
ADDRESS OF PRESENY BUI DING BITE
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PowerCompany ❑..................................................................................__
MAILqR ROMP, ADDRESS' J
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.
1
Signature of Owner,
Contractor, or
f..-. Ln.—.
ent Authorized Ag�.a::: _:..--.:<;_ � .......................................................
Signer's . s 7 1 `i1 ! 'l �` Phone ^ > / L;_1 j f
Address .....t...;....... No. -`!.-.::_c........:.......�.
city......--��:.......:....................................................................................
Date .......... Z::..`.:. ............ /............. ......................
.. - -
While Writing Applicatioul
�'pn •�mtY� PERMIT
NUMBER
NEW SITE ADDRESS
EDMONDS PRE -MOVE
INSPECTION �-
PERMIT NO.
FIRE BLDG� PERMIT NO.
'LONE 1 2 3 FOR WORK
AT NEW SITE
MOVE CONTRACTOR'S INSURANCE COVERAGE
NAME OF SURETY '� (�///11((1i,,�� ,,�� Jt e�7•- / pg
PROVIDING GE & d`/l.F�/-""�w'" �V�C' 1 '✓W
P.D. COVERAGE
STREET ADDRESS
, 0
zK ✓ f 1 ' STATE 1t � 1L
r
VALID INSURA CE P LICY CHECKED BY: DATE
BUILDING DESCRIPTION
DESCRIBE')BASIC CONSTRUCTION & PRESENT USE OF BUILDING:
JVE54L LENGTH OF BUILDING: ) L FT.
:EIGHT AS LOADED WIDTH AS LOADED BLDG. AREA
%
-) L=' P�.� T. FT. td 1
11 �' i
SO. FT. hl
POLICE �APP7VA,L�/Vll MOYONG ROUTE DATE
By:
to Commence Moving: ................
Time to Finish Moving: ............ ..1..aL1:%. ..
FIRE DEPARTMENT CLEARANCE
OF ROUTING
DAAT/E--ry r�
/3/7-F 1,419
RELOCATION RECEIPT NO.
PERMIT
PEE { Gl
ATTENTION:
PERMIT APPROVAL
THIS PERMIT
THIS PERMIT DOES NOT BECOME
AUTHORIZES
VALID UNTIL SIGNED BY THE
ONLY THE
BUILDING OFFICIAL OR HIS DEPU-
TY, THE FEES ARE PAID, AND RE-
CEIPT IS ACKNOWLEDGED IN THE
OF THE
SPACE PROVIDED
BUILDING
NOTED
Director's Signature
BUILDING
INSPECTION
DEPARTMENT
- -
Date ........� .w.- ,r........................
CITY OF
EDMONDS
DISTRIBUTION OF COPIES
PR 6-1107
WHITE — File (Bldg. Dept.)
YELLOW — Move Inspector
GREEN — Assessor
GOLDENROD — Police Dept.
PINK — Moving Contractor