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City of Puyallup I Engineering Services 333 S Meridian I Puyallup I WA 98371 Tel: (253) 841-5568 I Fax: (253) 840-6678 www.cityofpuyallup.org Rev: 09/12 City use only CHECKLIST: 1. Legal description of lot, lot(s) or property of relocation site: 2. Permittee must be the owner of the structure and the relocation site. Describe ownership documents reviewed. 3. (*)All owners, including spouse, shall sign this house moving agreement if applicable. 4. This agreement shall be recorded in Pierce County and a copy provided to the City of Puyallup. 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 WA STATE CONTRACTORS LICENSE No: Exp Date: Street Obstruction Bond No: City Business License No: Current Insurance: YES CG2012: YES Named Authorized Company Employee: YES City of Puyallup I Engineering Services HOUSE MOVE PERMIT APPLICATION PROJECT INFORMATION: Building Owner: Existing Site Address: Parcel No: Zoning: Proposed Site Address: Parcel No: Zoning: Proposed use or occupancy of the building: Please submit the following with your application: A detailed site plan of the proposed relocation site Proposed route, date and time Construction plans to bring the building to current building code Moving Agreement (if within city) A detailed cost estimate to bring the building to current applicable codes Application Fee - $110.00 APPLICANT Name: Address: City St Zip: Contact No: Email: ---PAGE BREAK--- AFTER RECORDING RETURN TO: CITY OF PUYALLUP 333 S MERIDIAN PUYALLUP WA 98371 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: Permittee 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 structure and clear the lot, and expend the security for such demolition and lot clearance. By: Date: PERMITTEE PRINT NAME By: Date: PERMITTEE PRINT NAME Approved: Date: BUILDING CODE OFFICIAL