1985, 02-15 Permit App: 00004206 Water Softener0)
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PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
6(4,
1 Owner's Name (Last) (First) (M)
Department Use Only
/v/
MAUTH Monty F
Project No.
2 Project Address (Not Mailing Address) Space Zip
E. 12403 Leonora . 99216
3 City/Community S okane StatWA
p
Subdivision/ Pl t Name
�1 V LZW -
4 Assessor Parcel No.
21543-0934
1 Lot
34
Block
1 JI
16 Contractor Firm Name
Soft Water Service Co.
Street Addres
E. 25 Third
17 ZipCity
99202
Spokane
State
WA
Phone
( 509) 455-8050
18 Contact Person l
License No.
Phone if different than above
8 Owner/Agent (If different than It1 above)
Business Address
9 Zip
City
State
Phone
l I
15 Describe Work. New ❑ ; Addition/Alteration ❑ ; Replace/Repair 0
Total Number
of Fixtures:
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
9 Bar Sink(s)'
Drinkl g Fountain(s).
Floor Drain(s).
Washing Machine(s)
10 DO Wshr(s):
Garb Disp(s):
Kit Sink(s):
Lndry Tray(s): I Sew Elect(s).
11 Urinal(s):
Wtr Closet(s):
Lav(s).
Shower(s):
I Tub(s)'
Bidet(sp
Other: Type; Water Softener
12 Waste/Grease Interceptor(s):
13 Sewer Y N Septic/Health No
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.
(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. APPLICATIOW15/85
OWNER OR AGENT DATE