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Department of Labor and Industries Pa�'�'" �°�� `hM� F�35.50 <br /> Factory Assernbled Strvctures �:�`� ; � � <br /> P�Box 44430 <br /> Olympia WA 48504-4430 NOTIFICATION TO L4CAL ENFORCEMENT AGENCY <br /> wrvw.wa.gov/lni/FAS/ �� <br /> (case sensitive) M 397 <br /> TAe Factory-Built unit idenrified beEow requires completian work at the Mfg - <br /> siteasspecified. WHITLEY EVERGREEN <br /> Owndsnazr�e EVERETT SCHOOL DIST. Mfg'sscr�aino. 0210-109-01/02 Deptser�alnc. <br /> Installatian address Type of construction Occiwancv �.TA at site <br /> . 10901 - 27TH AVE S.E. VB E <br /> City State ZIP+4 County Ptane number <br /> EVERETT WA 982�8 SNOHOMISH <br /> InstalEation site is in: � Clty ❑ County <br /> DESCRIBE ITEMS RE UIRING COMPLETION WORK AT TEiE SI'�E <br /> BUiLDING DEPARTMENT �LECTRICAL D�PARTIVIENT <br /> www.wxbo.org/ www.wa.gov/tni/electrical/ <br /> INSERT NAME AIVD ADDRESS[N SHADED AREA INSERT NAME AND ADDRESS IN SHADED AREA <br /> To: CITY OF EVERETT �0` DEPT OF L&I <br /> BUlLDING OFFICIAL 729 100TH ST. S.E. <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. h <br /> 4. MATELINE BOLTING &TRIM. vC� � .,� <br /> � <br /> ���, � <br /> ��� � <br /> , �� �� � <br /> : �L� ���� � <br /> � � <br /> . ��rz <br /> ���� <br /> inspxtor's name(prindty,pe� Phone:(8 am ro 5 pm). Manufacturer's name(prinUtypelWH ITLEY EVERGREEN, �0 <br /> ;�.�Ir'1 '�� ��`L���72 ic_SL ` �5 �( C' �_� (S <br /> Office location 1'�:e Manufa: s s e <br /> �%-,�i�z��f - ���L J��/�� /�� �� � <br /> For DepL Rec'd File By White-Olympia office <br /> Use ONLY / / Grern-Electrical scction <br /> Canary-(nspector <br /> F623-013-000 (PDF)notificatio�to local cnfoTtement agcncy I 1-00 ' � Pink-Building department <br /> � n,.iaa.....a r..��,....e. <br />