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1986, 03-31 Permit App: 00011018 Residence
(THIS IS NOTA PERMIT) BUILDING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 2,k se) COMPLETE IN INK �� (Please return this original and your building plans to the Department of Building and Safety) Vf U 'L.L innGI1J "1-1. ryrl tar-e.krI I IVI CIV 1 ML IJJC Project Number / ey/8 ! C/ Owner's Name LAST FIRST MI Tupper, Inc. Project Address (Street Name & Number) Zip . 14912 Broad Ave. Spokane, Wa. 99216 Applicant upper, Inc. Address E. 12929 Sprague City +pokane State Wa. Zip 99216 Phone (509 )928-1995 Business Phone (509 )928-1995 Contractor /Agent upper, Inc. Address E. 12929 Sprague City •.pokane State Wa. Zip 99216 Phone (509 )928-1995 Contact en or Debbie License Number (Required) TUPPEIR179DC Business Phone (509 )928-1995 Architect/ Engineer Address City State Zip Phone ( 1 Contact Business Phone 1 ) Lender Address City State Zip Phone ( ) q„;( Y .y .. "" ..... i cry. 41 'a • x z LIDt (` plat Humber PSI Zane , Comp. Ptee Cenaus Tract f r lrpitn4 tJn)ta Number of Buildings Lot Site (Sq. Ft./Acre) Dsptt Frontage Lett Setback .. Row Setback 6 .f #-o©r ENT USE Square Footage' d:4:6101 unfinished x.i6 1th level' unfinished 4. ra e . I-. . e" DEPARTMENTAL REVIEW I certify that I have examined this application and state that the information contained in it and submitted by me or my agent is true, correct, legal, and binding. Owner's Signature Date Approved p Appprrovov al Hold Environmental Health Permit Number W. 1101 College Room 200 Planning/Zoning N. 721 Jefferson Permit Number Engineers 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 is true, correct, legal, and binding. Owner's Signature Date • t1 1'0.00 - a1•111111111•1•1111, 101 L' Lore Go' LCie 1,01 //1 0 0 ,000pot f1 .27 ' ,CsArley 30 0 ?S 7 I i .3S" Concre1 c' t.7a a9z 1G/ ,o(1 t� �t 3 c, (3P?O)9 a AVE ADDRESS E. 14912 Broad Ave. STYLE LEGAL DESCRIPTION L9 B11 SUMMERFIELD EAST 2nd ADDITION q\i 3200 - C/ 4 th APPLICANT TUPPER POWER WWP JOB # 591 WATER TRENTWOOD FHA CASE # SCALE 1"=20'