0454_001Department of Labor and Industries CONVEYANCE
Elevator Section
PO Box 44480 INSTALLATION
Olympia WA 98504-4480 �,syT^'�
ww.Lni.wa.gov/TradesLiceming/Elevators
(360) 902-6130 _ APPROVAL BY
wAX(3n0) 9a2-61 2 BUILDING OFFICIAL
w.Lni.wa.gov/TradesLicensing/Elevators
➢ This form brings to your department's attention that the conveyance listed below is
proposed for installation in an existing building within your jurisdiction.
➢ Your approval of this form is required and must accompany the installer's Installation
Application.
➢ Notify the installer if you have any regulations that would prohibit this installation.
Do not approve this form.
*Note To Building Officials: The elevator section will approve LULA (Limited Use
Limited Application Elevators) for existing buildings, on a case by case basis.
A LULA elevator does meet the minimum cab size requirements for new construction
required to be accessible, per WAC 296-96.
If you have any questions, please contact us at the address or telephone number above.
Indicate the equipment being installed.
❑ Inclined Wheelchair Lift
Q✓ Vertical Wheelchair Lift The travel shall not exceed 14 ft. ASME Al8.1 Rule 2.7.1.
❑ Inclined Chair Lift
❑ Limited use/limited application (LULA) elevator *Does NOT meet accessibility
requirements for new construction.
All conveyances must be installed per code. Any deviation from the code shall require a
variance from the Department of Labor and Industries Elevator Section prior to a permit being
issued.
Name and License # of Installer of Conveyance
Mobility Concepts Inc MOBILCI962MZ
Telephone Number
253-896-0970
Building name where conveyance is located
Telephone Number/Location Contact
Ombu Salon & Spa
Beth Sanger (206) 327-4045
Street Address
City, State, Zip code
121 3rd Ave N
Edmonds WA 98020
0 Approved ❑ Not approved
ACKNOWLEDGED BY:
Title
Phone Number
Date.
1
Print name of building official
Signatu, of building official
,/
ij J
F621-056-000 conveyance installation approval by building official 05-2010