PSCAA NUMBER.pdfApproved Transaction Page 1 of 1
pscIeanair.org
Puget Sound ..,40...,.. Agency
Notification Case #: 201902992
is 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 # AAOF2EE35AD7
Transaction Date 06/11/19
Owner's Name Edmonds Senior Ctr. 512-5250 Phone (206) 515-5250
Project Street Address 220 Railroad Ave.
City Edmonds Zip 98020
Contact Person Jim Bray Phone (206) 515-5250
Mailing Address 1945 Yale Place East
Seattle, WA 98102
This project includes a demolition.
Demolition Start Date 07/01/19 Completion Date 08/31/19
Demolition will be completed by a demolition contractor
Demo Contractor Construction Group Intl LLC
Contact Mark Marcell
Mailing Address 19407 144th Ave NE Bldg D
Woodinville, WA 98072
Contractor Job # A19181
Phone (425)487-2618
(1) I certify that the information I have provided is to the best of my knowledge true and accurate.
(2) I 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) I 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) I understand the fees for this Notification are nonrefundable.
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If you have questions, contact us at asbestosCcbpscleanair.org or 206.689.4058.
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