REVIEWED RESUB1 BLD2023-1127- NLEA L&I FORM+11.1.2023_10.16.39_PM+3875851BLD2023-1127
Department of Labor and Industries Paid tum C �*
Factory Assembled Strictures S 45.00 f
PO Box 44430
Olympia WA 98504-4430 NOTIFICATION TO LOCAL ENFORCEMENT AGENCY
RE^v\ U ^ REVIEWED Doe�L••.(♦ BY 10/10/23 418-1
CITY OF EDMONDS
The Factory -Built unit idenHied below requires BUILDING DEPARTMENT' A'ffi CXTINC
compkHoa work at the site as spedtled- Nov 02 2023......................I..................
Owmesname City of Edmonds DEVELOPMENT SERVICES no. UFLUMONUb Dept serial no.
y DEPARTMENT OZI-319
Installation address Tra of V-B A at situ 06/01 /24
Mathay Ballinger Park — 24100 7811 PI W B
Phone rattnber
Edmonds, WA 98026 �7�no�hom h 425-599-3847
Instailadon site is in: 47.,�
LJ C.,
DESCRIBE ITEMS REQUIRING COMPLETION WORK AT THE SITE
rvcrnr v♦� ♦ ern ♦ nF%DCCC FV CUATISM♦➢VA
°
City of Edmonds
Bldg Official
250 5th Ave N
Edmonds, WA 98020
To:
Everett L&I
729 100th Street SE
Everett, WA 98208
ROOF DRAINAGE,
UNDERGROUND PLUMBING,
VENT PIPING, PLUMBING
CONNECTIONS
CUSTOMER WILL CONNECT
WATER SUPPLY & WASTE LINES
Plumbing: Min 1 1/2" meter and street
service
Plumbing Freeze Protection per local
AHJ approval
Connections between units
Foundation review and approval
Offfice location
For Dept. Rec'd
Use ONLY
File
an to
F623-013-OW notification to local enforcemrnt agency 11-98 m -44=p—
ELECTRICAL
Customer Provided Utilities to
Building
An electrical contractor/EL01
electrician licensed in WA State
is required to perform the
described electrical work.
Electrical Supply to 100A Interior
Panel Board
Site portion of the grounding
°"°°1 Ali Cairns
10 / 10 / 23 11 -� 646wd
White - otympia office
Gmen - Electic-al section
Canary - iaspactor
Pint - Building depamneat
Goldearod - C➢swater