Application_BLD2023-0336CITY OF EDMONDS M BuildingPermit.com
Plumbing Application #1284576
Applicant
First Name Last Name
Nicole Williams
Company Name
Pacific Bath Company
Number Street
17880 NE Airport Way
Apartment or Suite Number E-mail Address
110 jgreer@pacificbath.com
City State Zip
portland OR 97230
Phone Number Extension
(971) 264-0145
Contractor
Company Name
PACIFIC BATH COMPANY
Number Street
6521 SE CROSSWHITE WAY
Apartment or Suite Number
A
City State Zip
PORTLAND WA 97206
Phone Number Extension
(206)565-2030 (206)565-2030
State License Number License Expiration Date
SPECICN793OZ 8/31/2023
UBI # E-mail Address
FD357F144 jgreer@pacificbath.com
Project Location
Number Street
7104 180TH ST SW
Floor Number Suite or Room Number
City Zip Code
EDMONDS 98026
County Parcel Number
00504600001900
Associated Building Permit Number
pb21199
Tenant Name
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
Lisa Golitzin
Number Street
606 9TH AVE S
Apartment or Suite Number
City State
EDMONDS WA
Zip
98020
Certification Statement - The applicant states:
I certify that I am the owner of this property or the owner's authorized agent, including an appropriately licensed contractor. I have furnished true and
correct information. I will comply with all provisions of law and ordinances governing this type of construction work, whether specific herein or not. By
submitting this application I give the jurisdiction permission to enter the property to perform inspections. I understand that failure to comply with the above
may result in revocation of the permit.
Date Submitted: 3/17/2023 Submitted By: Nicole Williams
Page 1 of 2
i
CITY OF EDMONDS MyBuildingPermit.com
Plumbing Application #1284576
Project Type
Single Family Residential
Project Details
Fixtures
Shower, Tub or Combo
Activity Type
Repair or Replacement
Associated Building Permit?
There is no other onsite work that requires a building
permit.
Work Location
1
Scope of Work
Plumbing
Work Description/Location (example: 1st floor, Remove shower/tub combo install Walk in Shower
Master Bath, Garage) using existing footprint and plumbing
Page 2 of 2