HomeMy WebLinkAboutRequested Inspection - BLD Application - 6/5/1991 Delartmcnt of Labor&Industries APPLICATION FOR REQUESTED
C6nstruction Compliance Section � =
805 Plum St. 2nd flr HC 650 = INSPECTION Do NOT complete this block
PO Box 9689 f Col no
Olympia WA 98504-9689 (206)586-6085 "
Fees reed plans
NOTICE: Dealer/Contractor or Home Owner Inslgnla
--- ► YOU MUST CONTACT the nearest L&I Inspection office*to scheduleInspecaonj
TIME&DAY for inspection. Offices listed below.
--- Offices are ONLY open between 8:00 am and 5:00 pm Monday through Friday. Routed by a
- -01 NOTE: The insi nia fee is NON-REFUNDABLE. _ Dace - }
Owner Phone (between 8am�too 5�pm M-F) — �O o f: ,a
..nsignia # ...
..... /......
Address De er Phone
Ci% State ZIP A ess
e%-
Installer/Contractor ��>,W,.:.:..Phone City � ...�.v.,:.State..ZIP:..�
Aye',s
#Mobile Home Recreational Vehicle Commercial Coach
City.: State ZIP Contractors registration number
Please send completed application&check to the nearest ���������� �� ������•��-.,,-...�,..:..,...�•:_.�.,..........,_...,..,M._..,:...,.....,�
Make check payable to: Dept. of Labor & Industries #
L&I location listed below.
M
Plans # Technical Inspection: € Altcratlon i Wood Burning Fire Safety InspRe-Inspection#
$70.00 $50.00 $75.00 Appliance $75.00 $75.00 $50.00
�...
Descripti n of work -
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L rIGLtC *(J.[JU
Will Call Ready for inspection
z•••• Attach hand drawn map giving directions to location
tt aa�* �z nna¢atxarsatx>�x: uctaaa �:::.w��zs::>z:; z::rza?xszcava so:uaxx>;:xa�r:�zz?:::x1*11ZKxsMxa�e
r Mobile Home/Recreational Vehicle/Commercial Coach Serial No. Location of Vehicle s
Manufacturer
Y'^•K Date lgna licant or authoriz tative
Re-inspection required
Visual Inspection Complete ate ns or � -Phone
ABERDEEN *Dept. of La & Industries Mobile Home spectionY OfficesF`s1305 Tacoma Ave -305
2700 Simpson Ave. .._..:.. ...:....
Tacoma WA 02-1988
Aberdeen WA 98520-0013 EPHRATA
- 855
(206) 533-9300 21 C Street SW 1220 Memorial Hwy
Ephrata WA 98823-1895 Mt Vernon WA 98273-1406 VANCOUVER
BELLEVUE (509) 754-4608
(206) 428-1350 10401 NE 4th Plain �
300 120th Ave NE
Vancouver WA 98662
Bldg 4 e' 124 KELSO OKANOGAN
(206) 696-6295
Bellevue WA 98005
711 Vine St. 1234 2nd Ave S
(206) 455-7048/7074 Kelso WA 98626-2621 Okanogan WA 98840-0632
H WALLA WALLA i
(206) 577-2200 (509) 422-2550 1815 Portland Ave
BREMERTON
Walla Walla WA 99362-2269
4841 Auto Center Way •201 KENNEWICK OLYMPIA
(509) 527-4437
Bremerton WA 98312-3440
500 N. Moratn +`1110-A 805 Plum St SE, 2nd Slr
(206) 478-4558 Kennewick WA 99336-2607 Olympia WA 98504
WENATCHEE
(509) 735-0100 (206) 586-6085 123 Ohme Gardens Rd
EVERETT
Wenatchee, WA 98801-9620
Evergreen Way Business Center
KENT SPOKANE (509) 663-9713
8625 Evergreen Way *250 19435 W Valle Hwy wY E 3901 Main St
Everett WA 98206-1801 Bldg S *108 TAF C33 YAKIMA
(206) 356-2932 Kent WA 98032-2114
Spokane WA 99220-4033 1716 S 16th Ave
(206)81004 ryry-' i.Z 7a (509) 456-2793 Yakima WA 98909-5713
F622-012-000 APP FOR INSP. 12-89 (509) 575-2667
Department of Labor& Industries
Constructi%Compliance Section INSPECTION REPORT ,
805 PNm St SE 2nd fir
PO fox 9689 Phone number
Olympia WA 98504-9689 (206)586-6085
Date .......,,..-M�,,,...w..,....�...�,.-.,�.,,.M..
District office
Manufacturer/Contractor/or Installer M � Dealer
Address Address
.CityCity -.•..--,,..---...-V.
tate ZIP
Serial IVo. HUD No. -�
FInsigTu8 NO. Mobile homes Single wide
Commercial Coach ; i Double wide
Rec. Vehicle y�s Factory built TJBC
Park Trailer Field Technical Service
Owner iConssumer cv,o hint SA, HUD Ot er
0 Routine Complaint Uate o inspection
sRcqucsted
Adriress w .,.`:..:.......... ._....._M... In Plant w .._
�..� TEES DUE Iaspeeti°n Cce 7-- nsigni-a fee
City State Lll'�� M€VMake check payable:to: DEPT.OF LABOR&INDUSTRIES
__ ? Submit check to m is office at address_above.__ _Section Numbers Below Indicate Specific Violations Of Washington Rules And�Regulations. Violations Must Be
Corrected And Reinspection Requested Within 10 Days For Recreational Vehicles And Commercial Coaches; 20
Days For Mobile Homes. It Is Unlawful To Sell Or Offer For Sale Any Non-complying Mobile Home,
Commercial Coach Or Recreational Vehicle.
..�....�
Ord` .,
...... ARE VISUAL................................................................::............................... .... .. ...
INSPECTION FORMS WHICH MUST BE COMPLETED AND APPLICABLE FEES
.............
SUBMITTED BEFORE REINSPF.CTION.
.'„.•.:INCLUDED ARE APPLICATIONS FOR REQUIRED INSIGNIA WHICH MUST BE COMPLETED AND FEES
SUBMITTED BEFORE REINSPLCTION.
SEND COPY Tn MFG. ` "...
DEALER� OWNER ,
one num r iTafi
's
Inspector's Signature
y
_BLACKSMITH LAKE . ACREAGE, T RACT_S
MASON COUNTY, WA. Y
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