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Department of Labor and Industries � Arog Owner Requested Red <br /> Elevator Section <br /> PO Box 44480 Tag/Decommission Form • <br /> Olympia WA 98504-4480 44.4 mat <br /> Phone: 360-902-6130 • <br /> Email: ElevatorSectt Lni.wa.gov <br /> www.Lni.wa.bov/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 Date <br /> Imagine Children's Museum 02/10/2020 <br /> Owner Address <br /> 1502 Wall Street <br /> City State Zip Code <br /> Everett WA 98201 <br /> Phone Number Email Address <br /> 425-426-4217 accounting@imaginecm.org <br /> Building Information <br /> Building Name Conveyance Number <br /> 354 <br /> Building Address <br /> 1515 Pacific Avenue <br /> City State Zip Code <br /> Everett WA 98201 <br /> For copies of inspection reports, please visit: https:l/fortress.wa.bov/Lni/Lvtr <br /> To pay an invoice online, please visit: www.Lni.wa.gov/PayAnlnvoice <br /> LAI 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 />