1985, 09-11 Permit App: 00007440 Residence 31I8
` _ (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)
SHADED AREAS ARE FOR DEPARTMENTAL USE I Project Number .74.4ei lc,
Owner's Name LAST FI RST MI
Tupper Inc.
Project Address(Street Name&Number) Zip
E. 14921 Summerfield Court Spokane, Washington 99216
Applicant Address
Tupper Inc. E. 12929 Sprague Avenue
City State Zip Phone
Spokane Washington 99216 ( 509 ) 928-1991
Business Phone
( 509 ) 928-1991
Contractor/Agent Address
Tupper Inc. E. 12929 Sprague Avenue
City State Zip Phone
Spokane Washington 99216 ( 509 ) 928-1991
Contact License Number(Required) Business Phone
Ken or Debbie TUPPEIR179DC ( 509 ) 928-1991
Architect/Engineer Address
City State I Zip Phone
( )
Contact Business Phone
( )
Lender Address
City State Zip Phone
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DEPARTMENTAL REVIEW
Cond.
Appr.ved Hold
Approval
Environmental Health Permit Number � �+
_ l
El W. 1101 College l I
Room 200
Planning/Zoning
❑ N.721 Jefferson
Engineers Permit Number g.i!- —
❑ N.811 Jefferson -sgO
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 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 7--// ge-S
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ADDRESS E. 14921 SUMMERFIELD CT. STYLE HOME 2200-B
LEGAL DESCRIPTION L15 B8 SUMMERFIELD EAST FIRST ADDN.
APPLICANT TUPPER INC. POWER W.W.P.
JOB NO. 553 WATER TRENTWOOD
FHA CASE NO. SCALE 1"=20'
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