1985, 04-23 Permit App: 00005088 Plumbing Fixtures0,
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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