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� . — ���� �� �=�- -- <br /> Departrnent of Labor and Industries � pa;� _ C.oi� t'h-c4 Fn <br /> Faciory Assernbled Structures � .� � 35.50 <br /> P�Box 44430 � . �. � <br /> Olympia WA 98544-4430 NOT � C O '�� ' ENFORCEMENT AGENCY <br /> www.wa.gov/!ni/FAS/ �'�� ���` �� ! �" 397 <br /> (case sensitive) ,� �� � M <br /> The Factory-Bui}t unit idenrifted beEow requiresto��n k.g��e Mfg <br /> siteasspecitied. � W� WHITLEY EVERGREEN <br /> Owndsr�� EVERETT SCHOOL DIST. �f s crialno. 0210-107-01/02 Depts�a�nc. <br /> Installation address Type of conshvction Occuoancv EtA at site <br /> . 10901 - 27TH AVE S.E. VB E <br /> ��ty EVERETT Stase WA ZIP+4 98208 Co�nrySNOHOMISH ��crnunber <br /> Instaltation site is in: � City ❑ County <br /> DESCFtIBE ITEMS RE UIRING COMPLETION WORK AT THE SITE <br /> $UILDING DEPARTMENT �LEGT�2ICAL DEPARTMENT <br /> w�ww.wabo.org/ www.ws.gov/lni/electricaU <br /> INSERT NAME AND ADDRESS[N SHADED AREA iNSERT NAME AND ADDRESS IN SHADBD AREA <br /> T°: CITY OF EVERETT . T°: .DEPT OF L&I <br /> _.�_. <br /> BUILDI�NG OF��� _ __ _ _ . . . _,�� <br /> FICIAL ' 729 100TH ST. S.E. <br /> _ <br /> 3200 CEDAR ST, PO BOX, MAIL STOP TB-26 <br /> _ . __ _ _ _ <br /> EVERETT, WA 98201 EVERETT, WA 98208-3727 <br /> _ __ <br /> 1. FOUNDATION SYSTEM & TIE DOWNS 1. ELECTRICAL SITE CONNECTIONS <br /> 2. SKIRTING, DECK AND RAMPS 2. HVAC START-UP & TESTING. <br /> 3. ON-SITE ACCESSIBLE RESTROOM <br /> FACILITIES. <br /> 4. MATELINE BOLTING &TRIM. <br /> Insp�tor's name(prinVtype) Phonr.(8 am to 5 pm) Manuca���5 name c�Um�,WH ITLEY EVERGREEN, �0 <br /> ;� l��i�f'i,' : 7c=7��'L , [ 1� 2 �' u � 1 i � <br /> Office focation T r:- Manufac' 's e � <br /> �ti�.j��-r,— - `��1�,r� ;� <br /> FoC Dept. Rec'd File By te-Olympia office <br /> Use ONLY / / Grecn-Electrical scction <br /> Canary-Irsspector <br /> F623-013-000 (PDF)notification to local rnfoTcement agcncy f I-00 ,I�.% PinL;-8uilding dcpartment <br /> n,.iao...,,a r...-�,....o. <br />