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333 S. Meridian Puyallup, WA 98371IPhone: 253-864-4165IFax: [PHONE REDACTED] City of Puyallup I Engineering Services HOUSE MOVE PERMIT APPLICATION APPLICANT: Name: Address: City, St, Zip:_ Contact Email: CONTRACTOR: WA State Contractor License Expiration Date: Street Obstruction Bond City Business License CG 20 12: Y or N Current Insurance: Y or N Named Authorized Company Employee: Y or N PROJECT INFORMATION: Building Owner: _ Existing Site Address: Parcel Zoning: Proposed Site Address: Parcel Zoning: Proposed use or occupancy of the building: Applicant YES N/A City YES Documents ☐ ☐ Site plan for pro- posed relocation site ☐ ☐ ☐ Construction Plans to meet Current Building Code ☐ ☐ ☐ Cost Estimate to meet Current Build- ing Applicable Codes ☐ ☐ ☐ Proposed Route, Date, Time ☐ ACCEPTANCE CRITERIA Checked in by: Date: ---PAGE BREAK--- 333 S. Meridian Puyallup, WA 98371IPhone: 253-864-4165IFax: [PHONE REDACTED] HOUSE MOVING AGREEMENT IN CONSIDERATION of the issuance of a house moving permit for relocation of a structure within the corporate limits of the City of Puyallup, permittee named below agrees: Permitee shall render such structure suitable for human occupancy prior to the day of ,20 . Permitee shall post security in the form of an assignment of funds in the amount of $ . Such security is in the amount of the estimated demolition cost of the structure on its new site. In the event permittee fails to render the structure suitable for human occupancy prior to the date above, the City of Puyallup is authorized to enter the premises and property, demolish the struc- ture and clear the lot, and expend the security for such demolition and lot clearance. By: _ Date: PERMITTEE PRINT NAME By: Date: PERMITTE PRINT NAME Approved: Date: BUILDING CODE OFFICIAL Checklist: City use only Received Yes No All owners, including spouse, have signed moving agreement This agreement is recorded in Pierce County and a copy is provided to the City of Puyallup Permittee is the owner of the structure and the relocation site. Describe ownership documents reviewed: Legal description of lot(s) or property of relocation CERTIFICATION: I certify that I have read this application and declare under penalty of perjury that the information contained herein is correct and complete. Signature of Applicant: Date: SIGN