20140102170239539.pdfpscIeanair.org
Puget Sound Clean Air Agency
Single -Family Notification Case #e 201304352
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 # VT3FB499B602
Transaction Date
12/17/13
Owner's Name
Bdz Developers Inc Phone (425) 754-1592
Project Street Address 336 sunset Ave N
City
edmonds Zip 98020
Contact Person
Jim Henricks Phone (425) 754-1592
Mailing Address
3207 Pacific Ave
Edmonds, WA 98020
rhis project includes a demolition.
Demolition Start Date 12/27/13 Completion Date 01/03/14
Demolition will be completed by the home owner
I certify that:
(1) This is a single-family residence project. The structure is used by one family who owns the property as their domicile.
(2) The information I have provided is to the best of my knowledge accurate and complete.
(3) I understand the fee for this Notification is nonrefundable.
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If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058.
https://secure.pscleanair.org/Asbestos/Approved.aspx 12/17/2013