M-9-81.pdfIMPORTANT! Press Firmly While Writing Application!
Applicant Fill PERMIT 9
Relocation PermigInside Heavy Lines NUMBER J
I:BzJ �onst s Inc
s
t e r�
L
MAILING ADDRESB
EDMONDS PRE -MOVE
�
INSPECTION
PERMIT NO.
CITY A ZONE TEL. NO.
FIRE
,ONE I 2 3
BLDG. PERMIT NO.
FOR WORK
AT NEW SITE
_
:, _ _� n•� [ 743-4,'),
I
MOVING CONTRACTOR
MOVE CONTRACTOR'S INSURANCE COVERAGE
I: J �onst , Inc .
STREET ADDRESS
NAME OF SURETY
PROVIDING P.L. & Leader National Ins '"i0
1.� ' ' -1 . at� `19y .
P.D. COVERAGE
CITY &ZONE
TEL. NO.
STREET ADDRESS
307 "cic.csic7c ..:oad
Everett 93204
745-4220
CONTRACTOR'S
STATE CITY BUSINE88
CITY, ZONE &STATE
_
Indcpen::ellce 'vi110 44131
LICENSE NO. ^. ' i -, •� C- 37I LICENSE NO.
.
VALID INSURANCE POLICY CHECKED BY:
SITE DESCI;IPTI®N
(DATE
ADDRESS OF >;RE BUI NO -amp
-
BUILDING DESCRIPTION
eea Legal eee p On of . 1 e — (Show -below or attach four copies)
DESCRIBE BASIC CONSTRUCTION & PRESENT USE OF BUILDING:
^r ante �rzpt y
OVERALL LENGTH OF BUILDING: ,_ n FT.
Out of ``-%i.ty
or
FT. I t FT. SQ. FT.
POLICE L OF MOVINO ROUTE DATE
By: CG` o�
Time to Commence Moving: .. ...{..(.�. w........................ 1���/r I R+
Time to Finish Moving:........'l...Q.O...!.F-..`.......................... 6 r
FIRE DEPARTMENT CLEARANCE OF ROUTING DATE
W
By: -f_ /3/,//,p
U:L AREDREL FiY:
TION
Power Company .......................................................................................
PERMIT
Telephone Company 0 ................................................................................
FEE $ c
NAME OF OWNER OF PRESENT BUILDING SITE
Aai:;_ilisted Plastic I_1Iur;_;eons Inc
ATTENTION:
THIS PERMIT
MAIL OR HOME ADDRESS
AUTHORIZES
ONLY THE
r RELOCATION
I hereby acknowledge that I have read this appliection; that
the information given is correct; and that I am the owner, a
OF THE
duly licensed moving contractor, or the authorized ag, at of one
BUILDING
of these. I agree to comply with city and state laws regulating
NOTED
building relocation; and in doing this work, no per:,)n will be
employed in violation of the Labor Code, State of Washington
relating to Workmen's Compensation Insurance.
Signature Of Owner,
Contractor, Or
BUILDING
INSPECTION
Authorized A ............... ..........................
DEPARTMENT
Signer's Phone
Addrems S ..... No. 7Y-....14 .ea.....
CITY OF
EDMONDS
i
.EUP�?�i
City.......................................................................................................
. 1'R 0-1107
Date .....
........ . ..:(.........D./
DATE
RECEIPT NO.
1 L/sz19
PERMIT APPROVAL
THIS PERMIT DOES NOT BECOME-----
VALID UNTIL SIGNED BY THE -.R
BUILDING OFFICIAL OR HIS DEPU-
TY, THE FEES ARE PAID, AND RE-
CEIPT IS ACKNOWLEDGED IN THE i
SPACE PROVIDED
By ..... .................. 1r1.......�.�.D.t'r.4cL
Director's Signature /
Date ........ . k ..._
DISTRIBUTION OF COPIES
WHITE — File (Bldg. Dept.)
YELLOW — Move Inspector
GREEN — Assessor
GOLDENROD — Police Dept.
PINK — Moving Contractor