1984, 08-31 Permit App: 00002049 ResidenceBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return thin original and your building plans to the Department of Building and Safety)
1 Omura Nana (fast) (first) (m) ly
Deportment as OnOmuraTupper
, Inc. Rm./I
I
Comm
2 Prujert Address (not Mailing Address) a Road Name Space Zip
East 14622 Olympic Ave. (Job #573) Spokane WA. 99216
3 City/Cotrrmxdty
Spokane
State
WA
Subdivision/Plat Name
Summerfield East 1st Addn.
4 Assnsor Patel No.
Portion of 35643-9072
Lot
4
Block
6
* * * DEPARTMENT USE ONLY * * 1r
5 Sc Code
Zane Act. 0
Zone
e..,,f.(2._f_q
ProjectNo. :2_____e,
6 Dwell N
l
No. of Buildings
Sq. Ft./Acre
Depth
Frontage
7 Set Bads -Front
(L)S-1
(R)S-2
Rear
Census Tract
Module No.
Initis�
�/J cit._
16 Ar itect Firm Name
Street Address
Zip
City
State
Phone
( 1
Contact Person
Phone 11 different than above
( )
Contractor Firm Name
Tupper Inc.
Street Address
East 12929 Sprague Ave
Zip
99216
City
Spokane
State
WA
Phone
(509 ) 928-1991
Contact Parson
Ken Tupper or Debbie Kracher
License No.
TUPPEIR179DC
Phone If different than above
( )
8 Owner/Agent (If different than N1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
N
Plan Check (Y/N)
Y
Other (YIN) SEPA Exempt (YIN)
N
N I
Dads
4-25-84
15 Type Work DX Bldg
0 Fire
0 MH
0 Demo
[ New
0 Add/Alter
0 Replace
0 Move
b 1 h ga rage
14 Describe Werk
/ S 771((/////4i w�/�,' ei r./(/ /,Z/»7 2�
10 Applicant Name
Tupper Inc.
Street ddress
East 12929 Sprague Ave
11 ZIP
99216
City
Spokane
State
WA
Phone
(509 )928-1991
Lender
Street Address
Zip '
City
State
Phone
( )
Contact Person
Phone If different than above
( )
Additional Information
\ \4-(— AA F ,
62v CA r4
B 'f N 5
Fast Track/Special Ins
1
DEPARTMENT APPROVALS
■
•
Application Type
(Standard unless
otherwise Indicated)
Fast Track
Early Start
1 nis is jj a Permit
(Indicated approvals required In either "release" or "release with conditions'
space prior to permit issuance.)
Release
Release
w/cond 1
Hold 2
•
Environmental Health 0 Commercial; 0 Residential
W. 1101 College 0 New Construction; 0 Bldg alteration/addition
Room 200 0 Additional structure;
,�1 j�/
17/-100
APPLICATION0 T `CCJ`�'1�'
Conditions/ Comments- /0� Ala ' Al.I . .i I �.
' _.:01—.//
�A,
1
of
Planning/Zoning: 0 Commercial; 0 Cert. of Exemption; 0 Frontage;
N. 721 Jefferson 0 Setbacks; 0 lot w/d; 0 lot size; 0 use/zone;
0 CU, variance, zone change; shoreline; 0 fence;
❑ Other
Conditions/Comments.
•
•
Engineers: 0 Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage 0 0 fence;
.4,
new access/approach;
❑ road improvements
Conditions/Comments. ,c'A''A -..5-2,...?
•
Utilities:
N. 811 Jefferson
Conditions/Comments.
1111
Other:
E
Plan Exam
Fire Prev.
Conditions/Comments.
Informatlon ❑I
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for held
9 .06
e L -
4/6'
— eePkse nLerti - '.2 —
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Pico ' ci'/o//)-iie i
ADDRESS:
/ 4/ o? 2 (J/!//777%/L
LEGAL DESCRIPTION
STYLEc-J. CJ
L a 7- A/ .e/e) LJ Um/1Lf.� e /e �cS �/ s 7( /57n7/-<_.
APPLICANT /(L/0/621.�
JOB NO X73
SCALE 1" = 20' approx.
POWER LU a/ /'
WATER 72 2 7�GUCG'CL