1986, 03-07 Permit App: 00009910 Water SoftenerPLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
,4s
1 Project e QL% /CJ 'T
Owner's Name Last First MI
MILLER Lawrence 2 A.
Project Address (Street Name & Number)
City
State
Subdlvll n/Plat Name
RPL l' 04CVM 2nJD
Assessors Parcel a
2-65i/2— -7
Lot
-7
Block
iq
Plat a
Applicant
Same
Add ess
1905 S. Early Dawn Dr.
City
Veradale
I State
WA
Zip
99037
Phone
928-9543
Business Phone
Contractor
Soft Water Service Co.
Address
E.. 25 Third
City
Spokane
1 State y
W
Zip
99202
Phone
455.8050
Contact
License p
Business Phone
Describe Work
Bar Sink(s):
Drinking Fountain(s):
Floor Drain(s):
Washing Machine(s):
Dish Wshr(s):
Garb Dlsp(s):
Kit Sink(s):
Lndry Tray(s):
Sew Eject(s):
Urinal(s).
Wt Closet(s):
Lav(s):
Shower(s):
Tub(s):
Bidet(s):
Other: Type; Water Softener
Waste/Grease Interceplor(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:
(005+ :
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
OWNER OR AGENT Soft Water Service Co. DATE
APPLICATION