M-07-002 application.pdfOWNER'S
MA
IMPORTANT! Press Firmly W
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Applicant Permit Inside es
OF NEW BUILDING SITE NE
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g Application!
,� TIME
1N.PERMIT M,(77, 0
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MAILING ADDE88
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CITYj� r STATE "TEL, NO. _ I PERMIT NO. !�J I/ A a
` FIRE BLDG. PERMIT NO. _� -
��! ZONE 1 2 3 FOR WORK
MOVING CONTRACTOR
AT NEw SITE D 4
C MOVE CONTRACTOR'S INSURANCE COVERAGE
STREET AD SS NAME OF SURETY'-r�j�V���64s,��NSt �G�•+�-y
® PROVIDING P.L. $
P.D. COVERAGEP:.7 .-
SaS- 9. n1x1VIr ulew STREET ADDRE86��U �. Q:.652saa, Lim
CITY STATE TEL. NO,
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rvere WA WEA -1- ;64 % Qe`t s®A cl r, SO4#166 - 0 h
STATE / b , -iCONTRACTDR'S
STATE
LICENSE NO- L210 kVkeSkc� - vQMa Q) F6 Y i �
7i Of) LY
VALID INSURANCE POLICY CHECKED BY: DATE
SITE DESCRIPTION I:
ADDRESS OF PRESENT BUILDING SPIE . ATTACH LEGAL DESCRIPTION
37 0:1 MILDING DESCRIPTION
N,rAMME OF OWNER - - DESCRIBE BAS C GpNSTRUCTION & PRESENT USE OF BUILDING:
ADDRESS J)1�% PHONE
N f I �19/I�I../lr � IP' -�j OVERALL LENGTH OF BUILDING:�,Dd+ 0*1 -p-AA T. �" IT.
MOVING ROUTE HEIGHT AS LOADED WIDTH AS LOADED 113LdDG. AREA
f D i S fTVG W , !%6 kAM-M,23eror - F.T. 1 _ti. FT. lir r , 8@. FT.
0.1-oj/����r �� POLI DEPT._APPROVAL OF MOVING ROUTE DATE
_ru a 1 x331! 9;04PO4,6101K .._... ° a
Time to Commence Mo : . :.......... ...............
Time to Finish Moving: .��.......'........... _..... ��.._
FIRE DE TM T CLE41YANOE T FTOT'07co DATE
By:
y - -k ENGIN RING C ARANC DATE
SNOHOMISH COUNTYx /'Q ? S �pG - 3
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--w �� �, � ° � ab 6107 1
Power Company • ` 60A I' A6K l?<ti KCN PN1; RELOCATION FEE S RECEIPT NO.
PERT ,elepl u irk $ �G � ^ ��G' 3� iG
FEE
dLe ATTENTION: PERMIT APPROVAL
THIS PERMIT DOES NOT
i AUTHORIZES VALID UNTIL T CO
L S GNEDBY THE
ul—A"/�r e,,- ONLY THE BUILDING OFFICIAL OR HIS DEPU-
I herebi acknowledge that I have read this pplication; that RELOCATION TY, THE FEES ARE PAID, AND RE-
CEIPT IS ACKNOWLEDGED IN THE
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 Iaws regulating NOTED
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. By ------------- •.............. .......... ..-...........................
Building Official's Signature
Contractor, or
Signature of Owner, r� � W/ui`�f`� BIIILDING
I IV(3 ltkit: INSPECTION
Authorized Agent --•----...____.._.____•••------------ ---------------- DEPARTMENT Date
----------------------- •------------. --•------------------------
Addresss 17tJ 7w I �"'"` %� - 1 o e !D 1 7` C� CITY OF
.-• ........................----------- •--------••---••--•------------- EDMONDS
L-11i� DISTRIBUTION OF COPIES
City... ._.__._..,.�..-----.�------------------------------ State--V�.-------•---...-----
771-3202 VVB= — File (Bldg. Dept.)
`2 -26-7 YELLOW — Move Inspector
Date........------ ........................................................... .--------- ....--. ------• GREEN — Assessor
GOLDENROD -- Police Dept..
PINK — Moving Contractor