1985, 06-10 Permit App: 00005848 Plumbing Fixturesto
w
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
Owner's N
d
(Last)
2 Project Addresss Not Mailing Address
3 City/Community
$/ /CPlAr'7
(First) (M)
Subdivision/Plat Name
.Department Use Only
Project No.-.,
Zip
a Assessor Parcel No.
18 Contractor Firm Name
RIVER CITY PLUMBING INC.
Street Address
Di 111 Vista Bldg. 7,.
1T -21p
212
1sett Peraar.'
Audrey hobeck
City
S o�kane
State
Wa.
License*.
Na.
i RIVEPCPI9OKA
Phone
) 924-8028
;cone if different) an above
8 Uwner/Agent of different than *1 above)
Business Address
9 Zip
City
State
15, Describe Work: • New 0 ; Addition/Alteration 0 ;
Replace/ Repair 0
Total Number
of Fixtures:
10; Applicant Name
Street Address
9 Bar Sink(s):
Drinking Fountain (e):.
Floor Drain (s):
Washing Machlne(s1
10 Deft Wahrp):
Garb Diep(s):
Kit Sink(s):
LndryTray(a):
Sew Eject (s):'
11 Urinal(s):
Wtr Closet (s):
Lav(s):
Shower(s);
Tub(e): j
Bidet (s):
Type;
M. 12 1M1faete/Grease tnteroeptor(s):
X
U.
13 Sewer Y h•
Septic/ Health No.:
U) 14 Electric Water Heater(s):
i
Z
15 REPAIR OR ALTERATION:
Drainage, Vent, Water Piping/Treatment: Y N
Fp:ins-Roof:
16 Lawn Sprinkler System (s), including backflow device on anyone meter:
17 Vacuum breakers or backflow devices In excess of line 16:1-5:
(0r)5+:
I certify, that the above information as submitted by me is true and correct and further, agree that all pro.-
visions
ro-visions of laws and ordinances governing this type of work, including inspection requirements, will -Vii-:'`;
plied with whether specified herein or not. The granting of a permit does not presumeto give authority td
violate or cancel the provisions of any othe state of Coca aws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR=AGE
tICATIO
TE