1st E 8712 Appleway Chevrolet - Remodel (THIS IS NOT A PERMIT) L
BUILDING PERNlIT APPLlCATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOD UNDERSTAND
COMPLETE IN INK
(PleaBe return this orlginal and your buitding plans to the Department of 8u�lding and Satety)
SHADEO AREAS ARE FOR OEPARTMENTAL USE
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Pri.ng Corporati.on
P�"clect A�dress (Sireet Name !L Numoer) Zlp
E. 8712 First Av�e. Spo�can,e, WA 99212
Applic8lft A�ress
A�l�nr�.y Ch�ymlet,� E. 8500 Sbrague Av�
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Spok�ane U+�4 99212 �509 924-115Q
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Don Mathe�as N. 7703 A�
City Stete Zip Phone
Spokan�e, WA 992I6 509 928-5451
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ay me or my agent tv comp�le aaid applt�atfan is true anrf correct
S�ynature Date