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M-1-78.pdf
IMPORTANT! Press Firmly While Writing Applicatioul � Building Relocation Permit Applicant Fill Inside Heavy Lines �J PERMIT I NUMBER OWNER'S NAME NEW SITE ADDRESS GCINj . G'� FI ,vim MAILING ADDRESS G ..i �5t � t 9 —-�% EPRE-MOVE I INSPECTION �1 �+ t F CITY &ZONE q S I l'/ TEL. NO. •, _ + / PERMIT NO. ERMIT NO. I 3 RK "IR �ATN 1� N/ ( SITE MOVINGCONTRACTOR J o n/ s 7� , �. (J,` ' MOVE CONTRACTOR'S INSURANCE COVERAGE STREET ADDRESS NAME Or SURETY �� L- INID r td l PROVIDING P.L. & 1. ` 'V f�l ,q- ORA /3- 0 AJ P.D. COVERAGE CITY & ZONE TEL. NO. STREET ADDRESS Se,j-r IF - w.9s�, , �a- iy 7 -/ 3©2� CITY, ZONE &STATE CONTRACTOR'S CITY BUSINES6 STATE d � 3 ^O _a� Z ^ bC ffCENSE NO. LICENSE NO. O _ VALID INSURANCE POLICY CHECKED BY: DATE J SITE DESCRIPTION ADDRESS OF PRESENT BUIhIDING SITE 3�7 3 R� • s , t� i Gl a� �+� , S , BUILDING DESCRIPTION r.en,a n,.oe.•mtfnn or Prnuene n �- Rue — (show below or attach four copies) DESCRIBE BASIC CONSTRUCTION & PRESENT USE OF BUILDING: i.nnnl nrer�intinn of New Rite- site — (She J S LtJ 9 L- A! o 7 t- j /Q J S Power Company ❑ ..... Telephone Company ❑ __NAME OWNER OF PRESENT BUILDING SITE W -k , 6-' q,-t i-,-y, D MAIL OR HOME ADDRESS C( 0,')-Gj - t 5 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 Gi '-D 17v/ Ze2,9 Phone 14 ) Address............................................ .............No........�........................ City . iQL...... ---- LC/ �..... Date ....1._�..p7............................... ...... ... OVERALL LENGTH OF BUILDING: T)fne to Commence Time to Finish Me FT. GOADED I IILDG. AREA FT. 8Q. FT. (ING ROUTE DAT z.y1.r �� , T� o - c / o�S OF ROUTING DATE :�� fro ifP 'RING CLEARANCE n ION 1a: I I 1.1 61 DATE t° /y/Jd' w RECEIPT NO. S 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 By...... .... .............. ...............................--- Director's Signature BUILDING INSPECTION DEPARTMENT Date CITY OF EDMONDS DISTRIBUTION OF COPIES PR 6-II07 WHITE — File (Bldg. Dept,) YELLOW — Move Inspector GREEN — Assessor GOLDENROD — Police Dept. PINK — Moving Contractor