1986, 03-31 Permit App: 00011013 Residence(THIS IS NOT A PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
4 t 3
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)
bMAUtU ANtAJ AMt rUN UtiAN I MCIN I AL UJC
Project Number /4/6,3
Owner's Name LAST FIRST MI
Tupper, Inc.
Project Address (Street Name & Number} Zip
N. 4911 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; Agent
Tupper, Inc.
Add
E.
ess
12929 Sprague
City
Spokane
State
Wa.
Zip
99216
Phone
(509 )928-1995
Business Phone
(509 )928-1995
Contact
Ken or Debbie
License Number (Required)
TUPPELR179DC
Architect / Engineer
Address
City
State
I Zip
I
Phone
I
Contact
Business Phone
I I
Lender
Address
City
State
Zip
Phone
NN
SEP
Ire. j C (r4 .
aubdiviaion/Ptat Name/Short Plat Number 35?;i4/ 9( 75-G,C 77Z ,4 , ,� Lf.-(.,_-
• Siimmerfielrl Fact 2nr1 Arid itinn
Assessor Parcel Number
Lot
2
Block
10
Plat Number
Pertinent File NumbersZane
f-.('
Comp. Plan
Census Tract
Number ,t Dwelling Units
1
Plumber of Buildings
t
Lot Sire (Sq. Ft./Acre)
t o 000
Right Setback (
Fear
Depth
.*
Setback
Frontage •
12.,5
Front Setback k
Left Setback 1
Additional Information
1236 main floor
IDEPARTMENT USE
Square Footage
324 3rd level unfinished
546 4th level unfinished
484 garage
I+•1-
Group
Type .
Qul,dir9 Techniorrt
Oete
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health
❑ W. 1101 College
Room 200
Permit Number
Planning/Zoning
❑ N. 721 Jefferson
Engineers
O N. 811 Jefferson
Permit Number
Utilities
O N. 811 Jefferson
Plan Review/ Fire Prevention
O N. 811 Jefferson
❑
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
1 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 e\ -J
Date ����
~
°
�------ i �
3200C/4th
�
ADDRESS N. 4911 Lucille Rd. STYLE
LEGAL DESCRIPTION L2 810 SUMMERFIELD EAST 2nd ADDITION `,._
POWER wwr
APPLICANT TUPPER
JOB # 583
FHA CASE #
PERMIT #
WATER TRENTWOOD
SCALE 1`=20'