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100 : N. Main 719 REGIONAL PUEBLO: , Suite DEPARTMENT719 543543 0062 1 830 0002

PUEBLOConveyance : 81003 PermitFAX CO PHONEApplication TypeProjectInformation : : : : : : / : - - : . Replacement Project Code New : of Name : or City Mgmt : Alteration : Owner AddressCounty ( ) : Companyinstallation : : Zip Code Building Edition Address : : : County: : Code Zip City Name Email Phone Contact : : # Address Code City County Contractor : Zip Name : ) ContactState Email Name Fax License Phone | : 2. : ContactContract Valuation . Architect Scope of Work , Phone and 8.7 18.1 Code of Email 17.3 ASME 17.1 ( of , Description scopereferencethe A inthe space below project Describe A A sections the or

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: ) Number of Landings: * : : Conveyance : ( ) NOTE for : Application information : required ElevatorPermit indicates Stair alterations Moving Walk ( Material: : Dumbwaiter : : Type Rated Load or : Lift Size Lift of Means ( : Number ) Unit- ): Means of ) CarDrive of Suspension platform openings Suspension: ) lbs Interior Means of Number: Suspension Car material( Car NumberDoor ( other Mfg car ( ( : : Hoistway Car testinginterior HoistwayDoor Model Car Wt) or Up ( : 2 : InterlockWt SpeedSpeed : ) ( DepthClearance ) **Top ( fpm Overhead Runby (in.): : : Total Inside: Entrance : Interlock Totallbs : ( Dimension fpm Car ) **Bottom. Runby (in.): Construction Travel : Typeft Size in Pit # Down ft Stroke CwtSize lbs Rail Rail ) Buffer Guide Phase N) . Guide ) Sheave Type ft Guideft Rail in Size Buffer:

Hydraulic : Manufacturer MachineType : main- Hydraulic Type Volts On Vaive/ ( ) N ControlEmerg Model Emerg PrimaryBrake ( Valve Type Brake) Power ) ; . : Y Standby : # / Type : Battery Control CapBattery Safety / / Emerg Lowering SafetyOnly Safety# : ( # N ( ) - Volts : Approved: ) Y Manufacturer : : . Model : . Type : ( / : Governor Rope lbs ( : ( Model Slack / : Governor manufacturer : Governor Chain in N Fire , - N , Fire Machine Manufacturer : **Device Sprinklers / **Device HoistwayN / Model Switch Y N) , Evac Y Top/ : , ServiceFighter Rm Y Y DesignatedLevel Evac Y ' FireRoomCommandRunway/ of , Level Hoistway ) Sprinklers( - Pit in , , , , inAlt : Machine Sprinklers s , : ( Fire Rating Elevator , Rack, Rating 2 / ; and Screw , : C drum, , Passenger, Elevator, electric 3 Roped ; Winding pinion . drive Traction C 1 C Hydraulic hydraulic : - , ) Lift. ; Purpose . Freight A / or elevatorMoving/Special, Elev. Material Power Type . Stair LULAauto Sidewalk BElevA topType Walk Personal Dumbwaiter DumbwaiterLift w , of Type MaterialMaterial Material MovingElevator , Dumbwaiter transferDumbwaiterdevice B Escalator , Landings Openings Stairway: LiftChair lift , Number PlatformCar lift, , , . Vertical PlatformLift Inclined Lift Lift( ) I elevator of/ platform openingsdoors , , Bt Typeof or does ( arecounted : the dumbwaiter , Number car or not equal of fromand, rarely more 2 Drive , openings & , usually ) number , inside , or platformUnit Socket the landings is than Rack Cable Ball Chain : Chained - -, Direct and lift Roped Screw , penthouse :Traction hydraulicbasement, Directhydraulic, hydraulicWindingHanddrum Car - electric , , Tractiontesting machineE roomless, pinion hydraulicinterior Traction Othermaterial ASTM 723 252 Metal , 84 UL NFPA- , , Suspension Meanslaminatedglass , , shell gate Wire Steel Car Rope :Cable Coated / : : Elevatordoor or Aircraft , / Belt Chain C O Single speedtwo speed : speed , , Entrance three vertical power Buffer , parting collapsible Construction sideslideType bi ’ , Sheetrock Masonry Reduced, Stroke Bumper Rail Type Tee , Concrete: , SafetySpring Oil C Guide Other TypeA B, Other I Formed , : Governor Non - Other Fighters Service & , Type Flyball ballFly- Fire None Phase II Friction, , I Phase

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Conveyance Permit Application . Signature Applicant .

5 my above and accurate are the the of knowledge that statements true certify to and all Title Signature best belief Date name

Printed

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