1986, 08-12 Permit App: 00012340 Residence(THIS IS NOT A 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)
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Project Number i '2 3 9 0
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Owner's Name LAST FIRST MI
TUPPER, INC.
Project Address (Street Name & Number) Zip
N. 4921 Burns Road, Spokane, Washington 99216
Applicant
TUPPER, INC.
Address
E. 12929 Sprague
City
Spokane
State
Washington
Zip
99216
Phone
(509) 928-1991
Business Phone
( 509) 928-1991
Contractor; Agent
TUPPER, INC.
Address
E. 12929 Sprague
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
Zip
Phone
( )
Contact_
Business Phone
( )
Lender
Address
City
State Zip Phone
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DEPARTMENTAL REVIEW
I certify that 1 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
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Apprrovov al
Hold
Environmental Health Permit Number fr-- 0)•i94
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W. 1101 College
Room 200'
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Planning/Zoning
N. 721 Jefferson
Permit Number
'%� ..67/Z
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Engineers �� ,,
N. 811 Jefferson NX/1 l_ ii'a?
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 1 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
IPE -_7/22/86
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ADDRESS: 4921 Burns ` - f:
LEGAL DESCRIPTION: L 1.4 B 6 Summerfield 1st Addi on/
APPLICANT: Tupper, Inc.
JOB #: 535
FHA CASE #:
POWER' WWP
WATER: Trentwood
SCALE: 1" = 20`