REVIEWED BLD2022-0071 PSCAA DemoREVIEWED
RECEIVED
pscIeanair.org
Puy et Sound Clean Air Agency
Notification Case #: 202200833
BY
CITY OF EDMONDS
Feb 18 2022
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
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 BLD2022-0071
Credit Card Transaction # AGOA5C217A27
Transaction Date 02/18/22
Owner's Name CA Senior Living Holdings, LLC Phone (312) 248-2091
Project Street Address 21200 72nd Ave W
City Edmonds Zip 98026
Contact Person Owner's Representative Phone (312) 248-2091
Mailing Address 130 E Randolph Street, Suite 2100
Chicago, IL 60601
This project includes a demolition.
Demolition Start Date 02/28/22 Completion Date 09/30/22
Demolition will be completed by a demolition contractor
Demo Contractor Dickson Company Contractor Job #
Contact David Dickson Phone (253) 472-4489
Mailing Address 3315 South Pine Street
Tacoma, WA 98409
(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.