1985, 05-06 Permit App: 00008250 Water Softener•
7
X
X
L1
0
O
W
to
2
Z
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M) Department Use Only �.
BROWN Gail Project No � � w
i
2 Project Address (Not Mailing Address) Space Zip
N. 4622 Lucille 99216
3 City/CommunityState
Spokane
I WA
Subdivision/ Plat Name
4 Assessor Parcel No
I Lot
Block
16 Contractor Firm Name
Soft Water Service Co.
Street Address
E. 25 Third
17 Zip
99202
I City
Spokane
State
WA
Phone
(; 509 455-8050
18 Contact Person
I
License No.
Phone if different than above
8 Owner/Agent (if different than 41 above)
Business
Address
9 Zip
City
I State
Phone
( 1
15 Describe Work: New X ; Addition/Alteration 0 ;
Replace/Repair ❑
Total Number
of Fixtures:
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( I
9 Bar Sink(s):
Drink) g 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):
Levis):
I Shower(s).
I 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.
(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 APPLICATION
Soft Water Service 5/6/85
OWNER OR AGENT ce Co. DATE