1985, 10-31 Permit App: 00008490 Residence (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
' Project Number
Owner's Name LAST FIRST MI
TUPPER INC. •
Project Address(Street Name&Number) Zip
E. 11409 - 26th Spokane, Washington 99206
Applicant Address
TUPPER INC. E. 12929 Sprague Ave.
City State Zip Phone
Spokane Washington 99216 (509 (928-1991
Business Phone
( 509 )928-1991
Contractor/Agent Address
TUPPER INC. E. 12929 Sprague Ave.
City State Zip Phone
Spokane Washington 99216 ( 509 ) 928-1991
Contact License Number(Required) Business Phone
Ken or Debbie I UPPEIR179DC ( 509 ) 928-1991
Architect/Engineer Address
City State Zip Phone
t 1
Contact Business Phone
1 )
Lender Address
City State I Zip Phone
i Is Fami I Res i dente
'.8ub lv1$ nf.Pd Narneffilhorf PIM umbM:;,.
Kokomo Townsite
Assessor Parcel Number Lot Block Plat Number
: 28543`3227 20 32 ,
Pertinent Pile Number* Gomp.Plea Census Tract
Number of Dwelling Units Number of Buildings Lot Size(Sq.Ft./Acre) Depth Frontage
Trent Setback Left Setback Right Setback Rev Setback
Additional Information Square Footage
940 main floor
940 unfinished basement
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Building Technician Dale 1 Group Type
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DEPARTMENTAL REVIEW
Approved CpApproval Hold
Environmental Health Permit Number •
❑ W. 1101 College
Room 200 !
Planning/Zoning
❑ N.721 Jefferson
Engineers
Permit l
iitt�Numbber /b ?tf�S
❑ N.811 Jefferson p/,? 7/
Utilities
❑ N.811 Jefferson
Plan Review/Fire Prevention
❑ N.811 Jefferson
Other(SEPA/Critical Material/etc.)
❑ �r�
❑ 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
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LEGAL DESCRIPTION L2O B32 KOKOMO TOWNS ITE
APPLICANT TUPPER INC. P ER Inland
JOB # 885 k ER Model
FHA CASE # v.cC O J�� S4 '2 - .SLE 1"=20'
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