23302 76TH AVE W.PDFIIIIIIIIIIIIII
15147
23302 76TH AVE W
i
IP C. I S C) 11
July 7, 2004
GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH * EDMONDS, WA 98020 * (425) 771-0220 - FAX (425) 771-0221
Website: www.dedrnondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
Mr. Cerauti
23302 761h Avenue W
Edmonds, WA 98026
Re: Address Change Due to Change in Access
Dear Mr. Cerauh;
This letter is to inform you that due to a recent subdivision in your area, it is necessary
that your address be changed. This is so that your address is in accordance to the City
grid for Fire and Police. Your address has been changed from 23302 761h Avenue West
to 23230 76th Avenue West. I will inform all City Divisions including Fire, Police, Utility
Billing, Public Works and Building.
It is your responsibility to inform the Post Office, the Phone Company for Enhanced 911
emergency purposes and all other interested parties of this correction. We apologize for
the inconvenience this may cause you and greatly appreciate your cooperation.
Sincerely,
Marie Harri
Permit Coordinator
cc: Fire Department
Police Department
Utility Billing
Public Works
Building Official/Street File
Snohomish County Assessor
Address Files
L\Tcrnp\DST's\Master Letters\Address Change
Incorporated August 11, 1890
Sister City - Hekinan, Japan
07/21/2004 13:54 FAX 206 689 4073
PS CLEAN A P1 R 16001
FAX
Together For Clea n Air
TO
FROM
Name:
Ron DenAdel
Name:
Teri St( ry
Company;
Sound View Home
Company:
Puget S)und Clem Air Agency
Builders, Inc.
Fax:
(425) 670-3359
Fax:
(206) 6 19-4073
Phone:
Phone:
(206),619-4090
# of Pages:
I
Date:
July 21 2004
El URGENT 0 For review
El Please comment El Please reply [I Please recycle
Comments:
A Notice of Intent fortn is not required by Puget Sound Clean Air A ;,ency for the disassembly
and removal of the steel structure located at,,2-3-3,02,7,61kv*vexW; Edir onds, WA 98026.
Agency No. PUGET SOUND CLEAN AIR Date Received
AGENCY
110 Union Street Suite 500
Seattle, WA 98101-2038
www.pscleanair.org
Agency Use Only NOTICE OF RaTNT
DgWiWA Agency Use Only
1'ro*ectWx: 1. Q Friable Asbestos Removal 2. L3 Friable Asbestos Removal & Demolition 3. Demolition Only
Property Owner. TO ij Phone:
z
iling Address: C74 City: vw_eA State
C. Asbestos P1A4sZPRWCLHMdY. 7MVWLaBZy0VAKznawm41Lu�vL0EL.
Contractor:
Owner/CEO:
Contractor
Mailing Address:
Phone:
Job No.:
I City: 7
Zte:
Zip:
Fax:
D. Site
Address: ;C�302_ V) -��Jvko"A T.P: � aoz
Site Zko City:
Nfamger: 90,1 AOLZ I Local Phone:4,K1 737&f zX - 13
L U Asbestos Survey or -I
No. of
Date of Asbestos
Was Friable Asbestos Identified? UYes UNo
Q Mat'l Presumed
Structures:
Survey:
Was Nonfiriable Asbestos Identified? L]Yes L]No
Attach a copy of the survey when friable asbestos
AHERA Building
Certification
Inspector:
Exp. Date:
has not been identified
"I. � my W P �Jury "It "WWU#UWnPrUJUUL5
F. Demolition FsFui— No. of —F—IT-1 Training Fire (List Fire Dept)
5 Ordered Demolition (attach copy of Order)
Laformation: I Date: Structures: 12.
Demolition Insertd-11tion contractor's T*hng addressm back I Will nonhiable asbestos be left in place during demo? U Ye's No
Z - JA(
eV3 � 4
Contractor: kA I . t4w If yes, list type and qty.
IEL Asbestos/Demofition Project Categories:
Notification Period
Project Demolition
1. Single -Family Residence (owner -occupied):
Fee Surcha
A- Ll Asbestos Removal Project only
A. Prior Notice
A.- T$2 5
13!.��,Demolition Project (with or without asbestos removal project)
B. 10 Days*
B. $50
(Asbestos removal can begin upon notification, demolition must wait 10 days)
Note: If the singlefamily residence is owned by onefamily who has been or will be using the residence as their domicile, the above boxes
]A or 1B may be checked If tkis is not an owner -occupied residence, one of the categories flized below must be used A singlefamily
residence does not include rental property, multi-fwnily units, or any mixed-umuse bui ' .
2. U All Demolitions with no Asbestos removal or Nonfriable Asbestos
10 Days
$200
only
— Friable Asbestos Projects (other than Single Family Residence):
Asbestos Demo
370 �� 10 - 259 linear feet and/ora 48 - 159 square feet of asbestos
Prior Notice 10 Days
$100 $100
4. U 260 - 999 linear feet and/or 160 - 4,999 square feet of asbestos
10 Days
1 $200 $100
5. U > 1,000 linear feet and/or >5,000 s= feet of asbestos
10 Days
$750 $250
6. U Emergency Asbestos Projector U Emergency Demolition Project
f
Prior Notice
I
Twice Project Fee
(Single-� Residences are ex� fi-om mer cyfwhowevcr, property owners must videa
Sm
written emergency
L i certify that the information con)aftV in this no cation& supplemental data is, to the best of my lmowledge, accurate & complete. Agency Use., :Only
NOT S(>JAVJVJ'eV) �OhQ6M'
Signature Representing Dale "T Reviewed
Puget Sound Clean Air Agency Form No.: 66-160 (Revised 1/04) TS
G _5
061 - �O 7 -3 0 -� I @?5aAP4o""(,()f
c,(- - Lfc,�o
01
The Puget Sound Clean Air Agency requires advance notification before any person commences a friable asbestos project
involving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects
(regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation
H1, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency
forms. Asbestos removal and demolition Proiects involving materials and structures below the notification threshold are
still subiect to all other reQuirements of Regulation HL Article 4.
After receiving a complete notification with the app ropriate project fee, the Agency will review the form and return a
r.nnv M thp achAct ..A A ---I;+; 1_ ---*I �VL - -__ .. . . - -
u0nuaCE01 vy miam 11tv futtuUrnflicu Py will be your vandated notification.
J. Detuollition R
Contractor. ffo n Owner/CEO:
----------------
Mailing Address: e: Contractor's
*Phwn,! Job #:
[—City: E0tVW-t0k_) State: UJ ��Fax: !�F�
Zip:
_25 1
GUIDELINES FOR SUBMITTING AN ASBESTOSIDEMOLITION NOTIFICATION
Step 1. Check the appropriate project type in Box A. Friable asbestos includes popcom.ceiling material, sheet vinyl flooring, cement
asbestos board siding, and duct insulation. Nonhiable asbestos is normally found in vinyl floor tiles, window putty and most roofing
materials.
Step 2. Enter property owner information in Box B
Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single-family residential
project in Box C. Print clearly this is your return mailing label.
Step 4. Enter the site address for all notifications in Box D. For multi -structure projects, attach supplemental sheet with a site map
(include an address for each site) and a list of the type and amount of fhable asbestos to be removed from each structure.
Step 5. Check either asbestos survey or material presumed in Box E. All demolitions require that an Asbestos Hazard Emergency
Response Act (AHERA) asbestos survey be conducted by a certified AHERA building Inspector. Attach a copy of the survey to the
notification of a demolition proiect when only nonfriable asbestos or no asbestos is identified on the survey.
Step 6. Enter the project information in Box F. and check the training fire or ordered demolition box if appropriate (a copy of the
official order must be attached). All asbestos must be removed prior to conducting a training fire. Additional training fire
requirements are contained in Regulation I, Section 8.08. If any nonfriable asbestos materials will be left in place during demotition,
check yes and list the type and quantity of material.
Step 7. Enter asbestos project information in Box G. List types of friable asbestos material to be removed: surfacing material such as
popcom ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos board siding or pile, etc.
Step & For owner -occupied Single -Family Residential projects, check BOX H1A for renovation projects or BOX HlB for
demotition projects (with or without asbestos removal). Asbestos removal may be conducted after a complete notification is
received, but demolition activities can only begin on the I Oth day after the notification is received. Note. If the shigle famdp
residence is owned by onefamity who has been or will be using the residence as their domicile, boxes ]A or 1B may be checked. A
singlefamity residence does not include rentalproperty, multi-faindy uniis, or any mixed -use budding
For Commercial asbestos projects (or projects that do not qualify as Single Family Residential); check the project category HI -
5 that matches the amount of friable asbestos that will be removed. If a demolition is involved, include the appropriate surcharge
(additional fee) in your payment. To file for an emergency asbestos or demolition project, check the appropriate box I — 5 and the
applicable emergency box in H6. All emergMcy reguests must be accompanied by a letter from the property owner demonskLting
need to conduct the project immedigiLly in accordance with the Leguirements in Regulation III, Section 4.03 (c).
Step 9. Please certify the accuracy and completeness of the information provided by signing the notification in Box L
Mandatory amendments to the notification are required for changes that increase the project category, change the types of asbestos
materials to be removed and changes to start date, completion date and work schedule for asbestos projects. No fee is required for
work schedule. changes if the contractor is participating in the Agency work schedule fax program. A $25.00 processing fee is
required for all amendments.
Puget Sound Clean Air Agency asbestos regulations and forms can be downloaded from the Agency web page at www.pseleanair.org.
For technical assistance call (206) 6894058 and for administrative inquiries call (206) 689-4090.
Puget Sound Clean Air Agency Form No.: 66-160 (Revised 1/04) IS