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10/9/2019 Approved Transaction <br /> • <br /> pscleana r org <br /> Puget Sound Clean Air Agency <br /> Single-Family Notification Case #: 201905175 <br /> This page must be printed. A printout of the notification,all amendments to the notification,and the asbestos survey shall be available <br /> for inspection at all times at the asbestos project or demolition site(Reg III, 4.03(a)(6)). <br /> Fee Amount Paid $65.00 <br /> Credit Card Transaction # AK0A7A2F9402 <br /> Transaction Date 10/09/19 <br /> Owner's Name Carl Weber Phone (720) 272-7573 <br /> Project Street Address 1028 Lombard Ave <br /> City Everett Zip 98201-1538 <br /> Contact Person Carl Weber Phone (720) 272-7573 <br /> Mailing Address <br /> This project includes a demolition. <br /> Demolition Start Date 10/26/19 Completion Date 11/04/19 <br /> Demolition will be completed by the home owner <br /> I certify that: <br /> (1)This is a single-family residence project.The structure is used by one family who owns the property as their domicile. <br /> (2)The information I have provided is to the best of my knowledge accurate and complete. <br /> (3)I understand the fee for this Notification is nonrefundable. <br /> Create Another Notification <br /> If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. <br /> https://secure.pscleanairorg/Asbestos/Approved.aspx 1/1 <br />