1984, 07-03 Permit App: 00001148 ResidenceBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 owner's Narre (lett) (first) (m) Deportment Use Only
Tupper Inc. fie.
I
I Comm
2 Project Address (not Mailing Addres) ar Road Name Space Zip
N. 4916 Calvin Road (#520) 99216
3 City/Community
Spokane
State
WA
Subdivision/Plat Name
Summerfield East Addn
4 Asssor Parcel No.
Portion of 35643-9072
Lot
5
Block
2
* * * DEPARTMENT USE ONLY * * *
5 Sic Code
Pons Act. I
Zone
Project No.
6 Deal I
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Back -Front
(L)S-1
(R)S-2
Rear
Census Tract
Module No.
Initials
16 Architect farm Name
Street Address
Zip
Py
State
Phone
1 1
Contact Peron
Phone 11 different than above
( )
Contractor Firm Name
Tupper Inc.
Street
East
Address
12929 Sprague Ave
Zip
99216
City
Spokane
1 State
VA
Phone
(509 ) 928-1991
Contact Peron
Ken Tupper or Debbie Kracher
' License No.
l TUPPEIR179DC
Phone if dhlferent than sows --N
( )
8 Owner/Agent (If different then 11 above)
Business
Address
9 Zip •
City
State
Phone
( )
12 Review Required
N
Plan
heck (Y/N)
Y
Other (Y/N)
N
SERA Exempt
(YIN)
N
pate
4-25-84
15 Type Work
❑
Bldg
Fire
❑ MH
0 Demo
If New
0 Add/Alter
❑ Replace
❑ Move
Other
b I e garage
14 Describe Work
Single Family Residence
with double garage
10 Appliaint Name
Tupper Inc.
Street
East
Addrees
12929 Sprague Ave
11 Zip
99216
City
Spokane
State
WA
Phone
(509 )928-1991
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone 11 different than above
( 1
Additional Information
q(/' 4 I' 7- - - -4> -C-''.
z/fV- r-a/`t,e/
&!79 (LL- 6,1Yev.c-/".i/li
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
DEPARTMENT APPROVALS
This is nit a Permit
(Indicated approvals required in either "release" or "release with conditions"
space prior to permit issuance.)
Environmental Health
W. 1101 College
Room 200
Conditions/Comments-
0
onditionslComments-
❑ Commercial;
❑ New Construction;
❑ Additional structure;
L( Ccc(
APPLICATION #
❑ Residential
❑ Bldg alteration/addition
Release
Release
w/cond 1
Hold 2
7
II
W,il�a:
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
❑ CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions /Com men ts-
Engineers: 0 Commercial; 0 Residential;
N.811 Jefferson 0 drainage 0 new access/approach;
O road improvements
Condi tions / Com menta -
❑ Flood Plain; J7�TI)"
0 fence; ��
Utilities:
N. 811 Jefferson
Conditions/Comments'
Other:
onditions/Comments-
Other:
Plan Exam
Fire Prey.
Conditions/Comments.
Project Representative Telephone
Agencies Performing Special Inspection:
1
3
1 indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for held
ADDRESS N. 4916 Calvin Road
STYLE
LEGAL DESCRIPTION Lot 5, Block 2 Summerfield East Addn
APPLICANT Tupper Inc. POWER W.W.P.
JOB # 520
SCALE 1" = 20'
WATER Trentwood
MINE cfmry HET "T' DISTRICT