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� <br /> _ :�genry Case No. PUQ�'SOUND AIR POLLUTION CONTROi A CY e .c;er:ed <br /> � � 0 Union Street.Suite 500,Seatde. WA 98101-?0� �UL 31 � <br /> 200001181 NOTICE OF INTENT <br /> TO PERFORM: Nu,�'1 5 V�+�y�^,. <br /> Project 1'vpc• I sbestos Removal � ?. Asbestos Removal & Demalition 3. Demolition, No Asbestos Removal <br /> . Pro ert ,. 1 <br /> Owner:y (.�/ s ��- Phone: I�D(p) ��.i— �-� <br /> roperty OWner's 'Q � <br /> lailing .4ddress: ,��-� G � Cit : � s Stace: I Zio: �O/� <br /> . Asbestos � S-PAIM17ClL�RGY.THISWI(19EYOURRETURNM.UL.VGUHEL Contractor � /) �/ 1 <br /> Contractor <br /> � �p c �(� L' , OwnedCEO: i ra%�' /.� <br /> !/ �� Convzc[o: <br /> ;ailine .4ddress: �S'� � �T a � s� Phone: �L� Z,�� ��5� JobNo.: <br /> itv ��pJ�/J State• W�l— Zio: / �J�B I Fax: (�Z� a-S�- ���5� <br /> . Site �y <br /> Address: /y ���N-�-�- �A � I Citv: Scatc� ��' Zio: /$� O <br /> :ojec[ Managcr or <br /> untact Pcrson: �� �i t Phone: (�j ) 3$' — 8 � <br /> �5n�5to5 s�,�v�y o� No. oi / Date Sarvey was Was .4sbesros Eound? 1'es <br /> ❑ Mat'I Presumed: Structures: Conducted: oh- �C� ❑ If No, A«ach Su;�ey <br /> HERABuildin� ANaNER15UR'/EI'fSREQUlREDBEfOREeLL06N0UTlONPROlEC75 Expiration <br /> spector Name: ��..� ,�/N „S.�Q I Certification No.:�!�{. Da[e: po <br /> Demolition No. aC Start Training Fire(List Eire Dept. as demolitian con�ractnr below) <br /> Information: Structures: Date: ❑ Ordered Demolition(attach copy o(Order) <br /> Dl'fil0IlI10❑ I �RI,v7NeAlLNERE.fMER.HnIUNGAODRESSlN90d10.�'B�CS. IFTFAININGBURN£MERfIFEDEVTNEFE <br /> Con[ractor: Phone: ( ) <br /> i <br /> . Asbesms Project No. of Svuctures: Starc Completionp ��'k. Days: T �V Th Sa Su <br /> Information: (sec back if> 1) � Date: � / 0 U Datc: 0 � D Hours: -Fo � <br /> Wi11 all asbesms material be Yes / <br /> nal Ouantitv to bc Removed: Linear Ft. S uare Ft. f� (7 removcd bv roicct romoletion? NO ' � <br /> iermal Svstem Insulation: Boiler�fumace[ns. Duce Ins. Pipe Ins. Omer. <br /> �.rf�cing MaPI: Fireproofing Paints Plaster exmred Couines O�hcr. <br /> isc. Mat'h Cemene 6d. Cement Pipe ooring Mat'I . Roofing Mat'I Omer: <br /> . Asbestos/Demolition Project Categories: otifcation Waitin¢ Period I N- F N 4 � <br /> �Owner-Occupied, Single-Family Residenee Asbesros Removal Proiece P:ior Neuce ��^5 <br /> �7 Sm¢le-FamilY Rcsidence Demolition Yroiect - <br /> ❑ Al! Odicr Demolitions With No Asbestos Removal Proi�ct 10 P,ays � 51�0 <br /> 10-?�9 lincar fect or d8 - I59 s uare feet(sce back of form for options � Davs 51 SO <br /> 260•999 line.v feet or 160•d.999 sauarc feet I avs � 5300 <br /> 1.000•9,999 linear feet or 5.000-49.999 s uare feet IO Pavs � 57�0 <br /> I0.000-49.999 linear fect or 50,000-99,999 s u:ve fee: �'( Davs � 52,000 <br /> 50.000•99,999 linear feet or 100,000• 149,999 s uare feet � avs 55,000 <br /> 1 OO,OOQ+linear feet or 150,000+s uare feet 1�.• 10 Davs 5:0.000 <br /> Emereenc�•Asbestos Proiect or Emereencv Demolition Pr ' Prior Notice Twice Proiec�Fee <br /> Alternate Mcans of Compliancc for friable matcrials or Demolitions IO-Dav Rcview Period I Twice Prui«<Fec <br /> Alternare�leans ot Compliance for nonfriable asbesros materials � Concurrent with Proiect � Twice Proiect Fee <br /> 1 do hereby ccniFj ehat Ne infcrmauon conemned in �his nodfi<auon. and surp;ementi data desrnbed Aerein. it to the b<s� of my Co�nptuaneu R<�iaw <br /> wledge �ccurme and complete. I sh:ll oc� wuse or allow any +sbesms pre�:ct or demoli�ion ani��itiu to begin until ihe appropriam pe�fer.ned 8y <br /> eing penod hm elaps<d. <br /> �..G , )u� � �8 oa <br /> � Si�.:m:o Reprcsemin5 ��e Aee n�L� Onh <br /> � � <br /> .PG4Farm;lo 5T1[;�'�Rr:,:ea_ ... -. � <br /> 1 � <br /> . - d6E �40 00 BZ i�C <br />