BLD2022-0643+PSCAA+5.16.2022_6.49.11_AM+2871269psclea nair.org
Puget Sound Clean Arr Agency
Single -Family Notification Case #: 202202305
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 # AQ1A7E892F45
Transaction Date
05/16/22
Owner's Name
Gretchen Pawling and Jim Bailey
Phone (425) 830-1046
Project Street Address 755 Daley St
City
Edmonds
Zip 98020
Contact Person
Lee A Michaelis
Phone (425) 830-1046
Mailing Address
20353 Fremont Ave N
Shoreline, WA 98133
This project includes a demolition.
Demolition Start Date 06/14/22 Completion Date 06/17/22
Demolition will be completed by a demolition contractor
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.