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jfll-r3 sf- <br />I, <br />Department of Labor and Industries <br />NOTIFICATION TO LOCAL ENFORCEMENT AGENCY <br />............ <br />WA > o Boa <br />Olympia WA 98504•4430 " <br />��e <br />Uue <br />z i 9� M l Z3 <br />The Factory -Built unit Identified below requltvs <br />Submitted to UcpL of Iy& I by <br />completion work at the site as specified. <br />manufacturer in single copy <br />Cinncr's name <br />W©r�-s <br />Mf t'a serial M. <br />�q -i <br />At>3,�,o,r, <br />Dept aerial no. <br />.,d <br />InsEallatiot, address <br />W <br />ype o cons etion Occu cy <br />V�% <br />ET st dt <br />w� Intl <br />IVY <br />6 2 q <br />Cit o' �' tale +4 <br />vjA Zo ( <br />County <br />-2A/0 <br />n11 5'r+ <br />one mum r <br />Installation site is In: [i) <br />City ❑ <br />County <br />DESCRIBE ITEMS REQUIRING COMPLETION WORK AT THE SITE <br />To: Z-�- l l l of %ver-F� <br />To: <br />L (L-9 ) f2e-VT. <br />SZ��G—ED�il2 `�T <br />wj2�IcE ��ipP <br />�y-Cc-i�Ic� <br />�� c' i �,y� �U Z�► <br />r2il COfvk 111 'p <br />I, <br />�J'. VIIDIN C I <br />�� 76 'fT 51�tlLC� V.0 E <br />Nt12 NOPU65 LcO/JeC-c1JS <br />Z <br />I IJS FCTI0NS fJC LvUe; <br />EIZ� qL-A IzAl r::�Guieli&, SY,7�1 <br />C,UA)QA J m <br />L j20UN O C_ �O <br />UCTVIL/it- AlVC f -Ci2 IG ILE c <br />EII)151-1 (rM PC F ICtJ IIIGOULE 77111U�7L6 <br />L�,�i <br />,E21I 11�CI G� R 'I`�GwI�I_(li)CH �ZIt1 1 <br />il <br />2r I E:j21�Y ✓}Ti \C /{CC�S <br />J_v tI d 1 NC cG IU kX4f_TI c: fU 5 l .f <br />w 1) <br />SAL- HVA.6. N1UCL C <br />c h TIFY2 eVVC <br />VC f�li <br />SET � ColutU�CT <br />V. .C. C�IUDEI AC <br />�'f117S <br />Ins to s nam <br />IL lk-it�zs <br />one: am t) 3 Pin <br />zyo�3 <br />Office location <br />Z v e r <br />�� <br />Date <br />//01/ <br />a nam <br />For Dept Redd File <br />Usc ONLY / / <br />Fee <br />By <br />White - Olympia office <br />Canary - Building official <br />S <br />Pink - Inspector <br />F623-013-000 notification to local enforcement agency 7-93 Goldenrod - Manufacturer <br />