2400 33RD ST 2018-01-02 MF Import

ATTACHMENT A: Transfer Contact Information Both the previous Permittee and the new Peimittee(s) must sign this form. Type of Transfer (check one) Provide the date that the new operator assumed responsibility for the site. ❑ Partial Attach additional sneets if necessary. ® Complete Previous Permittee Information Permittee's Name: Jim Edwards Company Name (if applicable): Sound Transit Permit H WAR-007330 Mailing Address: 401 South Jackson Street City: Seattle State: WA Zip: 98104-2826 Phone Number: 206-39R;5000 Email: edwardsi0soundfrans8.ora 'For a partial transfer, the original Per ittee must submit an updated permit application form (NO1) indicating the reduced acreage of site (Total Size of She, and otal Di Acres (Signature) New Permittee Information I. OPERATOR NEW Permittee if. SITE OWNER Contact Name Phone No. Owner's Name Phone No. Jim Edwards 200 398-5436 Title Title Dep Director Chief Engineer Company Company Name Sound Transit Unified Business Identifier (UBI) 9 digit number provided by Dept Unified Business Identifier (UBI)9dgrtnumberprovldedbyneptof Revenue to business owners. Individuals without a UBI, entern" Revenue to business owners. Individuals wvMour a UBI, enternm N/A Mailing Address Mailing Address 40 i South Jackson City State Zip + 4 City State Zip + 4 Seattle WA 98104-2826 Email address Fax No. Email address Fax No. edwardsj®soundtransit.org 206-398-5216 III. ON -SITE CONTACT Person IV. BILIJNG ADDRESS Same as Cenif led Eroslon & Sediment Control Lead Contact Name Phone No. Contact Name Phone No. Title Title Company Name Company Name Mailing Address Mailing Address City State Zip + 4 City State Zip + 4 Cell Phone Email Address Fax Number (optional) Date new operator assumed responsibility and liability for permit coverage: Month Day Year ECY 020-87a (Rev 12/05)