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BLD2021-0367+Application+3.12.2021_11.35.00_AM+2089143CITY OF EDMONDS MyBuildingPermit.com Building Application #934089 - Ace Senior Care Home 2 Applicant First Name Last Name Company Name zena biru Number Street Apartment or Suite Number E-mail Address 19615 88th Ave W aceseniorcarehome(D_gmail.com City State Zip Phone Number Extension Edmonds WA 98026 2064050044 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 19615 88TH AVE W City Zip Code County Parcel Number EDMONDS 98026 00549200000602 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 Zena Biru Number Street Apartment or Suite Number 19615 88th Avenue West 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: 3/12/2021 Submitted By: zena biru Page 1 of 2 CITY OF EDMONDS M BuildingPerrnit.cam Building Application #934089 - Ace Senior Care Home 2 Project Contact Company Name: Name: Address: zena biru 19615 88th Ave W Edmonds WA 98026 Project Type Single Family Residential Email: aceseniorcarehome@gmail.com Phone #: 2064050044 Activity Type Adult Family Home Inspection Only Project Name: Ace Senior Care Home 2 Description of Work: No remodeling work will be done. Project Details Single Family Additional Use Adult Family Home Page 2 of 2