1986, 12-10 Permit App: 00014464 Water SoftenerPLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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Owner's Name Last First MI
KIELBON, RICHARD
Project Address (Street Name & Number)
City
State
Subdivisioy Plat Name
VII DiL(-,i4e, 3re
Assessors Parcel#Lot
C5
2 3351/- ee
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Plat #
Applicant Same
S. 3501 Loretta Dr.
S.
City I
Spokane
State
WA
Zip
99206
Phone
924-2951
Business Phone
Contractor
Soft Water Service Co.
Address
E. 25 Third
City
Spokane
State
WA
Zip
99202
Phone
455-8050
Contact
License #
Business Phone
Describe Work
Bar Sink(s):
Drinking Fountain(s):
Floor Drain(s):
Washing Machine(s):
Dsh Wshr(s):
Garb Disp(s):
Kit Sink(s):
Lndry Tray(s):
Sew Eject(s):
Urinal(s):
Wtr Closet (s):
Lav(s):
Shower(s):
l
I Tub(s):
Bidet(s):
Other: Type; Water Softener
Waste/Grease Interceptor(s):
Sewer Y N Septic/Health No.:
Electric Water Heater(s):
Drains -Roof:
REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: Y N
Lawn Sprinkler System(s), including backflow device on any one meter:
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 Co.
OWNER OR AGENT DATE