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department of Labor and Industries p,;a Colw� C*-�� p�s i <br /> Fac2ory Assernbled 5tructures � 35.50 <br /> P�Box 44430 <br /> Olympia WA 48504-4430 NOTIFICATTON TO LOCAL ENFORCEMENT AGENC`Y <br /> vm�v.wa.gov/lni/FAS/ ��` 397 <br /> (csse sens{tive) M <br /> The Factory-Buitt unit idenrifted beiow requires completion work at the Mfg <br /> site as specified. WHITLEY EVERGREEN <br /> Ownds name - Mfg�s serial no. Dept serial nc. <br /> EVERETT SCHOOL DIST. 0210-108-01/02 <br /> Installation address Type of construcrion Occunancv �TA at si[e <br /> . 10901 - 27TH AVE S.E. VB E <br /> C�ty EVERETT Stsie WA Zip+a 98208 ��""`�SNOHOMISH �nenumbcr <br /> Instaitation site is in: � City ❑ County <br /> DESCRIBE ITEMS RE UIRING COMPLETION WORK AT THE SITE <br /> SUILDING DEPART'MENT ELECTRICAL DEPARTMENT <br /> www.wabo.org/ w�ww.ws.govlfni/elec�-icaU <br /> INSERT NAME AND ADDRESS IN SHADED AREA iTSERT NAME AND ADDRESS IN SHADED AREA <br /> _ <br /> °' CITY OF EVERETT °' DEPT OF L&I <br /> BUILDING OFFICIAL 729 100TH ST. S.E. <br /> _ <br /> 3200 CEDAR ST. PO BOX, MAIL STOP TB-26 <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. "v <br /> � <br /> �/� <br /> �f. �,�'�,, t�," <br /> c.� � �, O� : <br /> ��C� �`'oi <;� .�'' <br /> � � D <br /> O� <br /> �'�g' <br /> Ins tor's name U ) Phone:(8 am Io 5 pm) Manufacturer's name(prinUtypel <br /> � �P`i"�''� WHITLEY EVERGREEN, Io <br /> '�(,7-aZ ('�. "^`��C7Jc_�� i Cl� .Z �=Z � j j [�' <br /> Office locatio D�:c Manufac 's i e, <br /> L=L�>C�--r�` . �/ iZ�i/J � <br /> FoC DepL Rec'd File By te-Olympia office <br /> Green-Elextrical scction <br /> Use ONLY / ! <br /> Canary-Inspe:tor <br /> F623-013-000 (PDF)notification to local enforeement agcncy l 1-00 /1 � Pink-Building department <br /> J• n�ue.,.,.a �•....�,..,.e. <br />