1985, 05-06 Permit App: 00008248 Water Softenerw
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M)
FALMO Ne
Department Use Only
J Project No. t )
2 Project Address (Not Mailing Address) Space Zip
E. 8621 ifiumoocKnox 99212
3 City/CommunityState
Spokane
JA
Subdivision/Plat Name
4 Assessor Parcel No.
Lot
Block
16 Contractor Firm Name
Soft Water Service Co.
Street Address
E. aifdi 25third
17 Zip
99202
City
Spokane
State
WA
Phone
( 509) 455,8050
18 Contact Person
License No.
Phone if different than above
8 Owner/Agent (If different than M1 above)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work: New 7[] ; Addition/Alteration ❑ ; Replace/Repair ❑
Total Number
of Fixtures:
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
9 BarSink(s):
1 Drinking Fountain(s):
Floor Drain (s):
Washing Machine(s):
10 Dsh Wshr(s):
Garb Disp(s):
Kit Sink(s):
Lndry Tray(s):
Sew Eject(s):
11 Urinal(s):
WtrCloset (s):
I
Lav(s): 1
Shower(s):
I Tub(s):
Bidet(s):
Other: Type; Water Softener
12 Waste/Grease Interceptor(s):
13 Sewer Y N Septic/HealthNo.:
14 Electric Water Heater(s):
Drains -Roof:
15 REPAIR OR ALTERATION: Drainage, Vent, Water Piping /Treatment: Y N
16 Lawn Sprinkler System(s), Including backflow device on any one meter:
17 Vacuum breakers or backflow devices In excess of line 16: 1-5:
(00 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 L'o.
APPLICATION 5/6/85
OWNER OR AGENT DATE