Fillable Extension Request Elevator Safety 150 Des Moines Street (State of Iowa - OCIO)

Fill Online, Printable, Fillable, Blank Extension Request Elevator Safety 150 Des Moines Street (State of Iowa - OCIO) Form

Use Fill to complete blank online STATE OF IOWA - OCIO (IA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Extension Request Elevator Safety 150 Des Moines Street (State of Iowa - OCIO)

On average this form takes 6 minutes to complete

The Extension Request Elevator Safety 150 Des Moines Street (State of Iowa - OCIO) form is 1 page long and contains:

  • 1 signature
  • 4 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

U.S.A. forms for State of Iowa - OCIO

BROWSE STATE OF IOWA - OCIO (IA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Iowa Division of Labor
Elevator Safety
150 Des Moines Street
Des Moines, IA 50309-1836
Phone: 515-725-5612/515-725-5608
Fax: 515-242-5076
james.borwey@iwd.iowa.gov
www.iowaelevators.gov
Installation/Alteration
Extension Request
$100.00 – Extension Fee
Approved Denied
Extended through:
Initials: Date:
Complete the entire form. Submit the completed form, supporting documents and $100.00 check or
money order to the address above.
This request will be denied if more than 12 months have passed since the initial application was received.
Individual Completing Form
Name
Title
Company name
Fax number
Email address
Address
City
State
Zip
Conveyance Information
Building name
Address/location
City
State
Zip
State ID:
Duration of extension request:
(length must be justified) 30 days 60 days
Initial
application date:
Describe in detail the reason for the extension
Signature Date
02.21.2020
600-018
FOR OFFICE USE ONLY
Submit this request during the 10
th
month of permit issuance - IAC 71.5(6)
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Extension Request Elevator Safety 150 Des Moines Street (State of Iowa - OCIO)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document