REVIEWED RESUB1 BLD2023-0001+PSCAA NUMBER+2.16.2023_10.20.41_AM+3373142CAN
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Clean Air Agency
Single-FamilyNotification Case #:
BLD2023-0001 RES U B
202300456 Feb 162023
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTM NT
This page must be printed. A printout of the noti ication, 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)).
Gee Amount pad WOO
Credit Card Trani xljon - AROAa?E222Sa
Tearmcwn Cate
02/01/23
Owrw*s t+iww
Ryan Crossman
Prolect Street Address 19902 Maplewood dr
Ccy
Edmonds
Contact Person
Ryan Crossman
MaiYng Address
19A02 Maplewood Dr
Edmonds, WA 99026
This prooW W4kides a deenoaeb .
Cemci tcc Swart Cate 02/28/23 CcrnptetmDMe 07/29/23
Cr',cbt oc r be completed by VW how owner
(206) 335.0437
98026
(206) 335.0437
certify that:
(1) This is asingle-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.gov or
206.689.4058.