1986, 03-27 Permit App: 00011144 Residence 3' 9 . cl
(THIS IS NOTA PERMIT)
.. BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE tieik ' -
Owner's Name LAST FIRST MI
Himalaya Hames inc.
Project Address(Street Name&Number) Zip
14917 E. 11th Avenue
Applicant Address
Himalaya Homes, Inc. 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 Freya — Suite 203
City State Zip Phone
Spokane WA 99202 (509 ) 535-6602
Contact License Number(Required) Business Phone
Zak Parpia HIMALHI161DE22301 (509 ) 535-6602
Architect/Engineer Address
City State Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State Zip Phone
( )
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DEPARTMENTAL REVIEW
Cond.
Approved Approval Hold
Environmental Health Application#
❑ W.1101 College
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers( c2`707
❑ N.811 Jefferson
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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Signat 3 Date //
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Address: .
14917 E. Ilth Avenue -' - "" -4
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