1985, 12-02 Permit App: 00009036 Plumbing Fixtures4'
_. PLUMBING PERMIT: APPLICATION WORKSHEET
PLEASE PRINT AND: COMPLETE ONLY•THOSE PARTS OF THE FORM YOU UNDERSTAND
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1 OwneiName '
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Department Use Only „..--
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Project No. C/136
r2 Protect Address (Net tailing Address)- - • Space ' 2 Zip
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3 City/Community ' ”' """ '„"'"
Slate ". .
Subdivision/ Plat Name
d . Assessor Parcel No r .
I Lot i
Block < - `
.... ....... ..
16 Contractor Firm Name
RIVER CITY PLUMBING INC. t
Street Address .
' N 111' Vista Bldg.- 7; D.' •
17 Zip ..Ctty
• 99212 -
_
I Spokane
State . " .
:,:.-a..ld'•,
Phone - -
( i 924-8028:.. _ '
• 18 Contact Person f; "
• AudreyY,fiobeck '
License No:,._ '- _
RIVERCP190KA,
Rhone If different than above •, . .. _
't8-Owner/Agent Of different than N1 above) .. - -
-
Business Address
9 Zip
City
State'. •
Phone
I )
15 Describe Work: New 0 : Addition/Alteration ., Replace/Repair 0 -
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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 Diap(s):
Kit Slnk(s): ,•
Lndry Tray(s):
Sew Elect(s)• '
11 tkInal(s): - - -
WI Closet(s): ./
Lay(s): �' _` •
• •Sh••owerls):,
J I Tub(s): /
Bidet (s). '
Other: Type; .
, 12 Waste/Grease Interceptor(s):
'13 Sewer ' Y' • N . . Septic/ Health No.: •
14 Electric Water Fieater(s):
Drains -Roof:
15 REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: ' Y N
16 Lawn Sprinkler System(s), including backl low device on anyone meter: '
'17' Vacuum breakers or backflow devices in excess of line 16:1-5' -'--•
Or)Str:
. 1 certify that the above information:`as •submitted3by me is, true and correct and further; agiee,that.all.pro-,
• visions of -laws and ordinances governtng,this type,of work, inctuding•inspection:requirements, will be-OiTHi:••
plied with:whettier•specified herein or'.not.'':Thegranting:.of'a -pep-twit:does:not presume to give authority
violateorcancelttie:provisions of'.any.othe' •tate of-locattaws regulating construction -or the performance•of*--1
construction:- y: • :.
SIGNATURE:OF::;: ; // APPLICATIONI
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...OWNER OR'AGENT. • • - `. DATE �-
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