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ROW Occupancy & Encroachment Agreement - Rockne House Move – Wolfe House Movers
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ROW Occupancy & Encroachment Agreement - Rockne House Move – Wolfe House Movers
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Last modified
4/23/2024 3:22:12 PM
Creation date
4/23/2024 3:21:54 PM
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Board of Public Works
Document Type
Contracts
Document Date
4/23/2024
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MOVING PERMIT APPLICATION (RESIDENTIAL) <br />APPLICANT INFORMATION DATE: <br />APPLICANT: ORG/BUSINESS: <br />PHONE: EMAIL: <br />ADDRESS: <br />Address City State Zip <br />PROPERTY OWNER: <br />PHONE: EMAIL: <br />ADDRESS: <br />Address City State Zip <br />PROJECT INFORMATION <br />STRUCTURE BEING MOVED FROM: <br />TO: <br />DIMENSIONS OF STRUCTURE WHEN MOUNTED (please note dimensions of ALL structures separately): <br />LENGTH: <br />WIDTH: <br />HEIGHT: <br />WEIGHT: <br />AXLE SPACING: <br />PROPOSED ROUTE: <br />FROM: TO: <br />FROM: TO: <br />FROM: TO: <br />FROM: TO: <br />FROM: TO: <br />FROM: TO: <br />MOVING CONTRACTOR: <br />*Must provide Certificate of Insurance showing requirements as listed in the City or County Code or Ordinances <br />I certify the above to be true and accurate to the best of my knowledge. <br />APPLICANT SIGNATURE DATE <br />PRINT NAME <br />VERIFY CONTACT IF DIFFERENT THAN APPLICANT EMAIL <br />PHONE <br />-20-
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