1984, 09-06 Permit App: 00002058 Water Softener•
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PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M)
OLSON. Randy G
Department Use Only .205-V
Project No.
2 Project Address (Not Mailing Address) Space Zip
11624 Lenora Dr. 99206
3 City/CommunityState
Spokane I WA
Subdivisnn//Plaatt Name
yr rceJ 49 t e3
4 Assessor Parcel NoLot
`/4- X1/2/ 1
k
Bleck
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16 Contractor Firm Name
Soft WaterService Co.
Street Address
E. 25 Third
17 Zip I
99202
City
Spokane
State
WA
Phone
(509 ) 455-8050
16 Contact Person
I License No.
Phone if different than above
6 Owner/Agent (If different than Ml above)
Business Address
9 Zip
City
State
Phone
15 Describe Work. New k ; Addition/Alteration 0 ; Replace/Repair ❑
Total Number
of Fixtures
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
9 Bar Sink(s):
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)'
Wt Closet(s):
Lav(s):
I Shower(sp
Tub(s).
Bidet(s):
Other: Type; Water Softener
12 Waste/Grease Interceptor(s):
13 Sewer V N Septic/ Health No•
14 Electric Water Heater(s):
Drains -Roof:
15 REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment' V 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'
(0r)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
OWNER OR AGENT Swum Soft Water Service co.
APPLICATION
DATE