1986, 03-27 Permit App: 00011143 Residence '5 C 1 3—'11
(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY FORM YOU UNDERSTAND
COMPLETETHOSE INPARTS OF THE INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE f -'
Owner's Name LAST FIRST MI
Himalaya Homes, Inc.
Project Address(Street Name&Number) Zip
14911 E. 11th Avenue
Applicant Address
es, Inc.
Himalaya Hom
S. 104 Freya - Suite 203
City State Zip Phone
Spokane WA 99202 (509 ) 535-6602
Business Phone
( )
Contractor/Agent Address
Zakir H. Parpia S. 104 Frey:5-35-S uite 203
CityStateZipPhoneSpokaneWA °920 . (509 535-6602ContactLicense Number(Required) BusinessPhoneZak ParpiaHIMALHI161DE22301 (5096602
—
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State Zip Phone
( )
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DEPARTMENTAL REVIEW
Approved CpApproval Hold
Environmental Health Application#
❑ W.1101 College
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers
ElN.811 Jefferson A4,4 A5-a.
Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention
❑ N.811 Jefferson
Other(SEPA/Critical Material/etc.)
❑ Fast Track/Special Inspection information
Project Representative Phone
Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
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