1986, 03-31 Permit App: 00010978 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)
Protect Number 1 0r/?8
Owner's Name LAST FIRST MI
Tupper, Inc.
Protect Address (Street Name 8 Number) Zip
N. 4901 Lucille Rd. Spokane, Wa. 99216
Applicant
Tupper, Inc.
Address
E. 12929 Sprague
City
Spokane
State
Wa.
Zip
99216
Phone
(509 )928-1995 •
Business Phone
(509 )928-1995
Contractor l Apent
Tupper, Inc.
Add ass
E. 12929 Sprague
City
Spokane .
State
Wa.
Zip
99216
p
1509 1928-1995 '
Contact
Ken or Debbie
License Number (Repro red)
TUPPEIR179DC
Business Phone
(509 ) 928-1995
Architect/Engineer
Add re;;
City
Stale
ZIP
Phone
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Contact
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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 3— Si/ G
Approved
Cond.
Approval
Hold
Environmental Health Permit Number
' W. 1101 College
Room 200
Planning/Zoning
N. 721 Jefferson
Permit Number
<j—/Q
Engineers
N. 811 Jeffersoni-
S
Utilities
N. 811 Jefferson
Plan Review/Firs Prevention
N. 811 Jefferson
Other (SEPA/CrItIcal Materiel/eta.)
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 3— Si/ G
1. •
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ILr
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ADDRESS N. 4901 Lucille Rd. STYLE 2200-B
LEGAL DESCRIPTION L4 B10 SUMMERFIELD EAST 2ND ADDITION
APPLICANT TUPPER INC.
JOB # 585
FHA CASE #
POWER WWP
WATER TRENTWOOD
SCALE 1" = 20'