REV 1 - 18FBS2200113_revised NLEA appr_flatSTATE OF WASHINGTON
DEPT. OF LABOR AND
INDUSTRIES
FAS PLAN REVIEW/SECTION
APPROVED
09/29/2022
SUBJECT TO CODE
AND FIELD INSPECTION
Department of Labor and Industries
Factory Assembled Structures Revised 9/29/2022
PO Box 44430
Olympia WA 98504-4430 NOTIFICATION TO LOCAL ENFO]
www.wa.i!ov/lni/FAS/
(case sensitive)
The Factorv-Built unit identified below requires completion work at the
site asspecified.
caner s name gr s serial no.
Edmonds Civic Center Pla field 21 20076
18FBS2200113
AGEN
Date
M 106 9/29/2022
g
Blazer Industries, Inc.
Went. serial no.
insta7 anon a ress Type o construction Occupancy ETA at site
310 6th Ave. N. VB I U
Edmonds WA 98020 Snohomish
Installation site is in: City County
DESCRIBE ITEMS REQUIRING COMPLETION WORK AT THE SITE
BUILDING DEPARTMENT
ELECTRICAL DEPARTMENT
www.wabo.org/
INSERT NAME AND ADDRESS IN SHADED AREA
Building Official
www.wa.gov/lni/electrical/
INSERT NAME AND ADDRESS IN SHADED AREA
L& I Electrical
250 5th Ave N
729 100th St SE
Edmonds WA 98020
Everett, WA 98208-3727
**See attached list of NLEA Items**
**See attached list of NLEA Items**
Plan Reviewer's name nn type one: am to pm
Michael Luke 360-902-5297
anu acturer s name (print/type
Blazer Industries Inc.
Office location
L & I F.A.S. Plan Review
Date
Manufacturer's signature
or ept. ec
Use ONLY
Pile
By
Olympia oitice
Electrical section
F623-013-000 (PDF) notification to local enforcement agency 11-00
...oF--
Building department
Customer
Replaces page 3 of 60 Expires 06/30/2023
STATE OFWASHIN ON 18FBS2200113
DEPT. OF LAB N
INDUST ES
FAS PLAN REVIE sERed 9/29/2022
APPROV D
09/
SU&WCTTOCODE Washington N.L.E.A.'s
AND FIELD INSPECTION
Contact the local Authority Having Jurisdiction for onsite permitting and inspection requirements.
1. Foundation plan review and inspection.
2. An accessible route shall be provided to the building area as required in IBC section 1104.
3. Electrical connection to service.
4. On site electrical service grounding, electrode system and bonding.
5. Required arc flash labeling per NEC 110.16
6. Available fault current field markings per NEC 110.24.
7. Electrical items provided and installed on site by others.
a. MCC
b. DP-1 MDP 400 amp 120/208 3-phase
c. LP-V
d. LP-S
e. Musco Lighting Panel
f. Irrigation Controls
g. Feeder Supply to 100A Factory Installed Panel
h. Pumps/Pump Disc's
8. Plumbing connection to service.
9. Installation of heat tape, when required.
10. Water heater pressure relief valve and/or drain pan disposal terminates at building exterior or an approved location.
11. Permit and inspection via local AHJ for water heaters having a volume greater than 11.25 gallons per Washington
State Boiler and Unfired Pressure Vessel Laws, Chapter 70.79 RCW and Chapter 296-104 WAC, by others on site
10 days prior to placing the equipment into operation.
12. Plumbing items provided and installed on site by others.
a. Floor sink, p-trap and drain. Blazer provided opening in slab, primer line and vent.
b. Eye wash and mixing valve. Blazer provided plugged hot and cold water supply lines.
c. Mop sink, p-trap, drain and faucet valve. Blazer provided opening in slab, vent and plugged hot and cold
water supply lines.
d. A 3/4" cold water supply with plugged fitting for possible future use has been provided in the event that a
diaphragm tank is necessary to add pressure to the system. If necessary, permitting and inspection from the
local AHJ will be required.
13. Insulation, vapor barriers, air barriers and draftstopping at marriage line installed on site.
14. Site installed exterior lighting.
15. Site completion or installation of siding, roofing, exterior/interior trim, floor covering and any electrical, plumbing
or mechanical crossover connections as they pertain to mod connections.
16. Site installed gutters & downspouts or roof drains as applicable.
17. Per WAC 296-15OF: The installation of interior equipment and appliances associated with the modular unit shall be
Single revision 9/29/2022
May be completed at factory
if materials become
available.
Replaces page 4 of 60 Expires 06/30/2023