20131126133150447.pdfApproved Transaction
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This page must be printed. A printout of the notification, all amendments to the notification, and the asbestos survey shall be
available for inspection at all times at the asbestos project or demolition site (Reg III, 4.03(a)(6)).
Fee Amount Paid $65.00
Credit Card Transaction # VXJFAE2689BO
Transaction Date 08/13/13
Owner's Name Pacific Ridge Homes
Project Street Address 8821 218th St. SW
City Edmonds
Contact Person Gary Cooper
Mailing Address 17921 Bothell Everett Hwy
Bothell, WA 98021
Phone (425) 438-9565
Zip 98026
Phone (425) 428-9565
This project includes asbestos removal.
Project Size linear feet / 40 square feet
Project Start Date 08/22/13 Completion Date 08/30/13
Asbestos will be removed by a licensed asbestos abatement contractor
Contractor Tri Point Industries Contractor Job # 130456
Contact Justin Lyles Phone (253) 514-8890
Mailing Address 10107 74th Ave NW
Gig Harbor, WA 98332-6801
This project includes a demolition.
Demolition Start Date 08/23/13 Completion Date 09/30/13
Demolition will be completed by a demolition contractor
Demo Contractor TBD Contractor Job #
Contact Phone
Mailing Address I
(1) 1 certify that the information I have provided is to the best of my knowledge true and accurate.
(2) 1 understand that I must file an Amendment to this Notification if:
® The type of project has changed. The project types are asbestos and demolition.
® The quantity of friable asbestos to be removed meets a larger project category.
* The project's start or completion date has changed.
(3) 1 understand one Notification must be filed for each structure. The only
exception is for a single-family residence that includes multiple ancillary
structures, such as a detached garage or other outbuildings having the same
street address. If there is no street address, I have used a building number.
(4) 1 understand the fees for this Notification are nonrefundable.
C.Mate Ano thcu,
Wevv i,fistor
If you have questions, contact us at asbestos@ pscleana i r, org or 206.689.4058.
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