1986, 03-31 Permit App: 00011014 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)
L/-31 64
Jr1MUCU Mr1C/1J / rt r U , ucrm t I IVICIV IML VJC
Projec' Number I /O 1[L
I 1
Owner's Name LAST FIRST MI
Tupper, Inc.
Project Address (Street Name & Number) Zip
N. 4914 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.
Address
E.
12929 Sprague
City
Spokane
State
Wa.
Zip
99216
Phone
( 509 928-1995
Contact
Ken or Debbie
License Number (Required/
TUPPEIR179DC
Business Phone
1509' 928-1995
Architect !Engineer
Address
City
State l
1
Zip
Phone
Contact
Business Phone
( i
Lender
Address
City
State
I Zip
Phone
( I
Describe Work
SFR
l s.
Comm.
1 Subdivision( Plat Name/ Short Plat Number e z- /7 5 / 'x%
DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health
W. 1101 College
Room 200
Permit Number
Planning/Zoning
0 N. 721 Jefferson
Engineers
❑ N.811 Jefferson
Permit Number
Utilities
0 N. 811 Jefferson
Plan Review/Fire Prevention
❑ N. 811 Jefferson
0
Other (SEPA/Critical Materlal/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 -3 ` >7— $ C
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ADDRESS N. 4911+ Lucille Rd. STYLE 2200-C111
LEGAL DESCRIPTION L1 B12 SUMMERFIELD EAST 2nd ADDITION
APPLICANT TUPPER POWER WWP
WATER TRENTWOOD
JOB # 6e Cs- 01
FHA CASE #
SCALE 1"=201
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ADDRESS N. 4914 Lucille Rd. STYLE 2200-C111
LEGAL DESCRIPTION L1 812 SUMMERFIELD EAST 2nd ADDITION
APPLICANT TUPPER
JOB # 600
FHA CASE #
POWER WWP
WATER TRENTWOOD
SCALE 1"=20'