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Application_1233076CITY OF EDMONDS M BuildingPermit.com Plumbing Application #1233076 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 permits@speconnw.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 permits@speconnw.com Project Location Number Street 20610 88TH AVE W Floor Number Suite or Room Number City Zip Code EDMONDS 98026 County Parcel Number 00873000000100 Associated Building Permit Number PB19510 Tenant Name Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Paul C Jaenicke Number Street 20610 88TH AVE W Apartment or Suite Number City State EDMONDS WA Zip 98026 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: 11/21/2022 Submitted By: Nicole Williams Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Plumbing Application #1233076 Project Type Single Family Residential Project Details Activity Type Repair or Replacement Scope of Work Like for like equipment in the same location Drains Floor Drain 1 Fixtures Shower, Tub or Combo 1 Associated Building Permit? There is no other onsite work that requires a building permit. Work Location Work Description/Location (example: 1st floor, bathroom Master Bath, Garage) Scope of Work Plumbing Page 2 of 2