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1985, 04-23 Permit App: 00005088 Plumbing Fixtures0, W D 1— X_ LL LL 0 W m i Z PLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name l\ /(Last) /� (First) (M) (170",,,i;74— " 0"1, 3 7 Department Use Only Project No. 2 Project Address (Not Mailing Address) / Space Zip 3 C% i.. C, 4/ U, A A S.� 3 City/Community f State Subdivision/Plat Name 4 Assessor Parcel No. !�Lot � �� J 1 Block 6—OF t. i 16 Contractor Firm Name RIVER CITY PLUMBING INC. Street Address N 111 Vista Bldg. 7, D 17 Zip 99212 I City I Spokane State Wa. Phone ( )924-8028 18 Contact Person I Audrey Hobeck License No. RI VERCP190NA Phone if different than above 8 Owner/Agent (if different than #1 above) Business Address 9 Zip City State Phone ( ) 15 Describe Work: New 0 ; Addition/Alteration 0 ; Replace/Repair ❑ Total Number of Fixtures: 13 10 Applicant Name Street Address 11 Zip 1 I City State _ Phone ( ) 9 Bar Sink(s): Drinking Fountain(s): Floor Drain (s): 1 Washing Machine(s): / 10 Deh Wshr(s): Garb Disp(s): Kit Sink(s): / l.ndry Tray(s): Sewl Eject (s): 11 Urinal(e): WtrCloeet(s): 2 Lav(s): 2 Shower(s): 2 1 Tub(s): / 1 Bidet(s): Other. Type; 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+: ca 2-- 1 1 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 2 APPLICATION DATES WS