1986, 01-14 Permit App: 00009904 Water SoftenerV)
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=r 4 PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state of local laws regulating construction or the performance of
construction.
SIGNATURE OF Soft Water Service Co.
OWNER OR AGENT
APPLICATION
DATE
1/14/ 86
/650
Project # /;%O tl-
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Owner's Name Last
xi SULLIVAN
First MI
Richard L
Project Address (Street Name & Number)
City
State
Su Ion/Plat N me
up � S36oN LLS
Assessors Parcel #
o
Lot
Block
Plat #
Applicant
Same
Address
N. 1804 Dartmouth
City Spokane
State 14A
"`t19206
Phone 924-0941
Business Phone
Contractor Soft Water Service Co.
Address E. 25 Third
City
Spokane
State
WA
Zip
99202
Phone
455-8050
Contact
License #
Business Phone
Describe Work
BarSink(s):
Drinking Fountain(s):
Floor Drain (s):
Washing Machine(s):
Dsh Wshr(s):
Garb Disp(s):
Kit Sink(s):
TLndry Tray (a):
Sew Eject (s):
Urinal(s):
WtrCloset(s):
Lav(s): _T
Shower(s):
Tub(s):
Bidet (s):
Other: Type; Water Softener
Waste/Grease Interceptor(s):
Sewer Y N Septic/ Health No.:
Electric Water Heater(s):
Drains -Roof:
REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: Y N
Lawn Sprinkler System(s), including backflow device on any one meter:
Vacuum breakers or backflow devices In excess of line 16:1-5:
(Or) 5+:
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state of local laws regulating construction or the performance of
construction.
SIGNATURE OF Soft Water Service Co.
OWNER OR AGENT
APPLICATION
DATE
1/14/ 86