1985, 12-20 Permit App: 00009207 Residence(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)
Project Number
Owner's Name LAST FIRST MI
TUPPER INC.
Project Address (Street Name & Number) Zip
N. 4911 Burns Rd., Spokane, Washington 99216
Applicant
TUPPER INC.E.
Address
12929 Sprague Ave.
City
Spokane
State
Washington
Zip
99216
Phone
( 509) 928-1991
Business Phone
( 509) 928-1991
Contractor /Agent
TUPPER INC.
Address
E. 12929 Sprague Ave.
City
Spokane
State
Washington
Zip
99216
Phone
( 509) 928-1991
Contact
Ken or Debbie
License Number (Required)
TUPPEIR179DC
Business Phone
( 509) 928-1991
Architect /Engineer
Address
City
State
I Zip
Phone
( )
Contact
Business Phone
Lender
Add ess
City
State
Zip
Phone
( )
S f= R
�tPlat tzpansIEtwr't PISA Number
--SUMMERFIELD EAST 1ST ADDITION
Assessor Parcel Number
35644-2616
Lot
16
Block
6
Pat Number
Pertinent File Numbers
Zone
Comp. Pian
Cense Tract
Number of Dwelling Units
_
Number of flu !dings
1
Lot Size (Sq. Ft. /Acre)
Depth L�
/ -G -w J
Frontage
P6
front Setback
30
Lett Setback
Right Setback
blear Setback
Ariditionaf Information
1210 Main Floor
DEPARTMENT USE
Square Footage
1184 3rd & 4th level unfinished
484 garage
tuning Technician
Date
--2C? -FS
/
fe-3 �
Type
wnl
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 — �5 J
Approved
Cond.
Approval
Hold
- �1
Environmental Health Permit Number 75-----43 /
( a
/
W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Permit Number
J ADAK
,i.ellIr
Engineers
�}
N. 811 Jefferson Aril- - i 37
/
Utilities
N. 811 Jefferson
I
Plan Review/Fire Prevention
N. 811 Jefferson
L
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 — �5 J
1
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L-'
11
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ADDRESS N.4911 BURNS RD.
^i T. Or C. z
STYLE HOME 2200-0111
LEGAL DESCRIPTION L16 B6 SUMMERFIELD EAST FIRST ADDN.
APPLICANT TUPPER INC.
JOB NO. 533
FHA CASE NO.
POWER W.W.P.
WATER TRENTW00D
HUD-FI4A tT
BUILCERS COPY