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�b,og-a3 5 <br />Agency case na I •.,.•�. ��–..– ---- <br />-..�;��., .. , . <br />110 Unic�� Street, Suite 500 <br />200500709 �`' � �::.�_�:� Seatlle,H'A 9810L2038 <br />www.pscicu�air.org <br />I _ NOTICE OF INTENT <br />APmry USt OnIV — <br />AUG 1 8 2009 <br />e v.�t.�� Tvoe: 1. ❑ Frlible Asbnto! Removd 2. Frl�ble Asbestm Rcmovd & Demotltloo 3. Qq Demolitlon Ooly � <br />Address: <br />C� <br />E. � Asbestos Survey or I No. of I Date of Asbcstos <br />❑ MaCI Presumed: Swcmres: � Survey: ' <br />A}iERA Building2 Cert�hcahon #: <br />laspector. v1���.�0�tl�l� Ezp.Da�e: (f <br />An AHERI Survn� u rrvryved M/�ve df d`mdiria� prprm <br />F. Demolidon Stnrt / No. of <br />Informetfon: Dnte���D/pj Structures: 1 <br />Demolilion IrutttJ:mahumawrtx:rv'+mmLngoL7mvmMn'k <br />ConVactor: ��q'��nJ�Wt /�C�*'le5 <br />Ctl! <br />Start Datc: � <br />� Local Phone: ()�(,( p/%G+ 5 US"1 <br />Was Friabic Asbestos Idrntifi�d? ❑ Ya � No <br />Was Non(ria61e Asbcstos ideNificd? ❑ Ycs No <br />Atmcb a mpy af �he sunry w�hen jriabe asbesros <br />� has not been identi�cA <br />I. ❑ Training Firo (List Firc Dept.) <br />2. ❑ Ordered Demalition (attach copy of Order) <br />Will non(riublc nsbatos be Icfl in place during demo? Ya No <br />I(yes, list type and qry. _ <br />Work Days: M T W Th F Sa Su <br />Date: � Hours: <br />Will all friable asbrstos material � Yes <br />�� No <br />Toml . to be Rcmoved: Lmear Ft. S unre Ft. be remov . <br />❑ Uuiler�Fumace Insuluiion ❑ Duct Insulution ❑ Pipe Insulntion ❑ Fireproofing ❑ Paints ❑ Plasta ❑ Textured Coatings <br />� �ement poard ❑ Ccmrnt Pipe Friablc fliwring ❑ Fnable M¢tcrial ❑ O�hec <br />!L ,��bes�oslDemolftlon Project Co�egoria: AMOUHT 1�— yO���catfon Periaf ProJect Demolitloo <br />Fre SurchorYe <br />I. Single�Femily Rnidence (owner occupled): CK- ��. S/O� <br />A. ❑ Asbctns Rctinaval Projcct (hily RL'PT A. Prior Notice A. 52 <br />[i. � Demolitinn Projcet (with or without acbcstos rcmoval pm�cct}y�' B. IU Days• . S50 <br />yAslx�tos rcmoval r.an h in u n notification: danolition must wait 10 clavs) <br />No�e: /j�hc single jamJy ruidenct is owntd by ant jamily who bas bem or will be asinq �he raidrnte u �htir damicUq �ht ubuve boxa IA orlB <br />may hr chtcked /jthis is na� an on�nrr�ccupied rrsid�nce, ont oJthe ta�rgorivlisted below must be attJ instead A ting(e jemJy ruidenet daa <br />not include ren�al rn r�, multi- umi! units, or anv mixed-use buildin . <br />2. ❑ All Oth�T Dnnoli�iuns (with no Asbectos Rcmuval or Nonfirahlc Asb�stos 10 Days 5100 <br />nnly or I��ss than 10 linuhr (cet and'or JA syuan (�tiK af Criable Asbaios) <br />G�ioma n.hr:�m Proire�s lother th�n Sinele Fomily Rnidence): Asbntos Demo <br />3. ❑> 10 - 259 linunr fcet or' 4N - I <br />J. ❑?60 - 999 linwr (cct ar 16U - 4: <br />5- ❑ I.000 - 9.999 lincv 0.�ct ur 5,011 <br />(i. ❑ P.mcTgency Asbcsias Projcct or <br />1 �m�% <br />.��/� <br />si�,�„r�.�� <br />(tty o( asbesros <br />fret uf ubatos <br />Emcrgcn�y Dcmolition Pmjat <br />rv fee: howner. omoertv �wms rtu+� o�vu�e � <br />10 <br />Prior <br />10 <br />m Uuf rou(w�Uon R iuppkrteNal dau i,.10 �he bm of my kmw�edye, accwale d carykle. <br />c��1 _- �L��(os <br />5200 SI00 <br />5600 f100 <br />S50 Emergrnry <br />