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Washington State Department of0 <br /> Conveyance Installation, RedTag, <br /> Labor & Industries Decommission, or Removal Approval <br /> Elevator Program by Building Official <br /> PO Box 44480 <br /> Olympia WA 98504-4480 1 <br /> Phone: 360-902-6130 32i C — OO9 <br /> www.Lni.wa.gov/Licensinq- I ` <br /> Permits/Elevators f /.� 0 J <br /> VV�� <br /> • This form brings to your Department's attention that the conveyance listed below is proposed for <br /> installation in an existing building with your jurisdiction. <br /> • Your approval of this form is required and must accompany the installer's Installation Application <br /> or the Owner Request Red Taq / Decommission Form. <br /> • Notify the installer or building owner if you have any regulations that would prohibit this installation <br /> or removal. Do not approve this form. <br /> For Conveyance Installation <br /> Note to Building Officials:The Elevator Program will approve LULA elevators (Limited Use Limited Application) <br /> for existing building, on a case-by-case basis. A LULA elevator does not meet the minimum cab size <br /> requirements for new construction required to be accessible per WAC 296-96. <br /> If you have any questions, please contact us at the address or telephone number above. <br /> ❑Approved ❑ Not Approved <br /> Indicate the equipment being installed: <br /> ❑ Inclined Wheelchair Lift <br /> ❑ Vertical Wheelchair Lift—The travel shall not exceed 14 ft. ASME A18.1 Rule 2.7.1. <br /> ❑ Inclined Chair Lift <br /> ❑ Limited use/ limited application (LULA) elevator(does not meet accessibility requirements for new <br /> construction). <br /> All conveyances must be installer per code. Any deviation from the code shall require a variance from the <br /> Department of Labor& Industries Elevator Program prior to a permit being issued. <br /> Name of Installer License Number of Installer Telephone Number <br /> Building Name where Conveyance is Located Location Contact Telephone Number <br /> Street Address Cit State Zip Code <br /> //J SE e('' rr AAfc_ 4✓4 y cif rr� D c✓err 14 9920 8 <br /> I <br /> For Conveyance Red Tag / Decommission / Removal <br /> Conveyance#: 36-7$v L( — LV i 13 a- £ 1,3 Approved ❑ Not Approved <br /> Acknowledge By: <br /> Name of Building Official Title Phone Number <br /> B12,4CLe y C1DJZ1u) rt1,4fn-r e,vc s e. A ss0Ci 1 re' �✓Jr vc e2 ( 2 ss) z s 7-$S/v <br /> Signature Date <br /> ii/r1>/z'ZZ <br /> F621-056-000 Conveyance Installation, Red Tag, Decommission, or Removal Approval by Building Official 01-2022 <br />