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Department of Labor and Industries STArgOwner Requested Red <br /> Elevator Section (:). <br /> PO Box 44480 Tag/Decommission Form <br /> Olympia WA 98504-4480 MS It <br /> Phone: 360-902-6130 <br /> Email: ElevatorSect(a Lni.wa.gov <br /> www.Lni.wa.aov/Elevators <br /> NOTE: You must provide the department with written approval from the building official, indicating that the <br /> conveyance is not required for building occupancy, when you apply to have the conveyance placed in <br /> voluntary red tag/decommissioned status. , <br /> A conveyance may be put into red tag status at the owner's request. Once in red tag status, the conveyance <br /> may not be used until it is inspected and has come into full compliance. While the conveyance is in red tag <br /> status, the owner is required to renew their annual operating permit. See WAC 296-96-01035 for fee. <br /> Decommissioning of your conveyance needs to be done by a licensed elevator contractor and verified by an <br /> inspection performed by the department. See WAC 296-96-01035 for fee. Decommissioned status has no <br /> yearly fee. <br /> Owner Information: <br /> Owner Name D to <br /> Ownerdress it <br /> �� ,,,1u cityar- ec .2�. - ,X71,.6- i �€ , ay Fly • <br /> City <br /> je <br /> Zip Code <br /> Phone Number 6 E ii Address <br /> a l - !o6,l- v t(00 crarfvN•ers c to!. CoIli <br /> Building Information <br /> Building Name Conveyance Number <br /> (VICI -• <br /> Building Address <br /> ?3a 0vcc Lee-A- (� <br /> City Sip Code <br /> 4 to03- 0,11 <br /> For copies of inspection reports, please visit: httos://fortress.wa.gov/Lni/Lvtr <br /> To pay an invoice online, please visit:www.Lni.wa.gov/PavAnlnvoice <br /> L&I Internal Use Only <br /> Sent to Elevator Inspector Emailed By Date <br /> F621-063-000 Owner Requested Red Tag Form 01-2019 Index: ORTAG <br />