Xerox Scan_0501202010453112/18/2019 Approved Transaction _.
pscIeanair.org
Puget Sound Clean Air Agency
Notification Case #: 201906242
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 # AKOA7B86A4F9
Transaction Date 12/18/19
Owner's Name Kisan Enterprises LLC Phone (425) 402-9900
Project Street Address 22810 Edmonds Way AEC Job# 19679
City Edmonds Zip 98020
Contact Person Naeem Icibal Phone (425) 402-9900
Mailing Address 20607 SR 9 SE
Snohomish, WA 98296
This project includes asbestos removal.
Project Size 20 linear feet / square feet
Project Start Date 01/02/20 Completion Date 01/02/20
Asbestos will be removed by a licensed asbestos abatement contractor
Contractor American Environmental Construction, LLC Contractor Job # 19679
Contact Dee Surface Phone (206) 267-0746
Mailing Address P.O. Box 81005
Seattle, WA 98108-1005
(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 asbestos@pscleanair.org or 206.689.4058.
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