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MOVING PERMIT APPLICATION (RESIDENTIAL) <br />S <br />t F_ I -1'j()S1`,PH COU-N-FY crn7oF�() "7`1 'H BFINI) BU ILD G D_ )ARTM-N <br />90-UW_-Tk%TVWf@T_.TkrjriTi MW <br />DATE: April 3, 2020 <br />APPLICANT: Lykowski Construction, Inc. ORG/BUSINESS: LVkOWSki Construction, Inc <br />PHONE. (574) 291-8858 EMAIL* k ath ylykows ki@ao 1. com <br />ADDRESS. 23158 W. Ireland Road South Bend IN 46614 <br />Address City State Zip <br />PRO'PERTYOWNER: Kapacinskas (Eric and Mia Martin) <br />PHONE: (812)360-8125 EMAIL: eric.vance.martin@gmall.com <br />ADDRESS, 804 S. Lincoln Street Bloomington IN 47401 <br />Address City State Zip <br />STRUCTURE BEING MOVED FROM: 1126 N. Frances St., South Bend, IN <br />TO: 522 Napoleon, South Bend, IN <br />DIMENSIONS OF STRUCTURE WHEN MOUNTED (please note dimensions of ALL structures sel3arateiv)- <br />LENGTH: 40'-0" <br />WIDTH: 23'-0" <br />HEIGHT- 31-0" <br />WEIGHT: 192,000# <br />AXLE SPACING: See attached sheet <br />FROM: 1126 N. Frances North TO; Napoleon <br />FROM: Napoleon West TO: 522 Napoleon (destination) <br />FROM. enter site from Hill St. at rear of 522 Napoleon TO: <br />FROM: TO: <br />FROM., TO: <br />FROM: TO: <br />MOVING CONTRACTOR: Lykowski Construction, Inc, <br />*'Must provide Certificate of insurance showing requirements as listed in the City or County Code or Ordinances <br />certify the above to be true and accurate to the best of my knowledge. <br />April 3, 2020 <br />4PP61CANT SIGNATURE DATE <br />-Kathy Lykowski for Lykowski Construction, Inc. <br />PRINT NAME <br />VERIFY CONTACT IF DIFFERENT THAN APPLICANT <br />WARD OFPUBLIC WORKS <br />Ga, AGil,A, 11­,id­ <br />F11i,AW, A. M,­dik, M,­be, <br />J.,q,h R. X1.1­, Member <br />J-d— V, C-b—, Ni-0— <br />Al MS I <br />Lind. M. M-fi, Clfl, <br />EXCELLENCE ACCOUNTAMLITY INNOVATION R,1C1..USJON EMFIOWERMENT <br />12.f', S. Laingttv Mvd Sr Iile 10C.) �:"Ou0l lknd' kl6nna,,66,01 ,,) 1J74 231,,95-54 ( 574.235 55,11 <br />