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BLD2021-0594+Application+4.26.2021_6.53.00_PM+2162688CITY OF EDMONDS nnyst,ilaingPermit.com Building Application #954212 - Montessori Academy Applicant First Name Last Name Company Name Warinda Bonqkotmart Montessori Academy, LLC Number Street Apartment or Suite Number E-mail Address 7712 234th ST SW wbongkotmart(&_gmail.com City State Zip Phone Number Extension Edmonds WA 98026 2068834328 Contractor Company Name Owner Number Street Apartment or Suite Number City State Zip Phone Number Extension State License Number License Expiration Date UBI # E-mail Address Project Location Number Street Floor Number Suite or Room Number 7712 234TH ST SW City Zip Code County Parcel Number EDMONDS 98026 00576700003113 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name Jirote and Warinda Bonqkotmart Number Street Apartment or Suite Number 7712 234TH ST SW City State Zip EDMONDS WA 98026 Certification Statement - The applicant states: I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work requires a licensed contractor to perform the work, the information will be provided prior to permit issuance. Date Submitted: 4/26/2021 Submitted By: Warinda Bongkotmart Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com Building Application #954212 - Montessori Academy Project Contact Company Name: Montessori Academy, LLC Name: Warinda Bongkotmart Email: wbongkotmart@gmail.com Address: 7712 234th ST SW Phone #: 2068834328 Edmonds WA 98026 Project Type Single Family Residential Activity Type Adult Family Home Inspection Only Project Name: Montessori Academy Description of Work: Applying for the use of day care for 10 children Project Details Single Family Additional Use Adult Family Home Page 2 of 2