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Department of Labor and Industries Elevator Section Inspection Report <br /> PO Box 44480 *One Conveyance per Report <br /> Olympia WA 98504-4480 <br /> Phone: 360-902-6130 <br /> Fax: 360-902-6132 <br /> www.Elevators.Lni.wa.gov <br /> New ❑ Alteration ❑ Annual ❑ Non-Annual ❑ 30-Day Permit ❑ Other. <br /> Permit Valid Until Permit ID# Date Inspection equested Date lnsppcted <br /> l i0 y�Z�1 O� 0 2 O2 49 zu23 <br /> Building or Location Name Conveyance m� and Type <br /> 147' <br /> Building or Location Address Location Number <br /> 001 I. <br /> Installer's Name and City <br /> � ssen ry l.Cr,-�l��a <br /> Description of Alternation: <br /> Code Box Reinspection Hours <br /> Correction Notice A: �� � ❑A-13 ❑ Invoice May Fallow <br /> 5 2t c c rly rr a a i 4iA_ _e__ ele c e-el C4 e <br /> 1 <br /> Print Contact Name Contact's Signature Contact Phone Number <br /> Print Mechanic's Name Mecha ' ' ignature Mechanic's License Number <br /> Print Inspector's Name - Inspector's Signature <br /> NIL,- nimielL 4J� <br /> F621-002-000 Inspection Report 02-2015 Index EIRPT <br /> White—Central Office Canary—Inspector Pink—On-Site Representative <br />