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1986, 03-25 Permit App: 00010283 Plumbing Fixtures47T-N-ri.TRIT-,11 4 PLUMBING P SAIT APPLICATION WORKSHEET ND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND PLE, ‘, • 1 Owner,iNear --:•,,. • ,. ,_ , (Tirst) (M) - / , - /4"-Prolect , r- ,._ -,, /.....,...,- , Department Use Only - _, •,•,- ..-••=...;,_ . No 2 Project Acidreqs (N9t Mailing . Space Zip /.-•7;'"- x , Cityli, e • , ' '1. 3 rS'tate Subdivision/ Plat Narne •,--.;,-•' ' .,, : ,k T.? .1'1,11, . •:,' :::, , :•., .1.•`,"1,,, •,. ,.'"'"$'4":...-:`; ,•,., ,.. ,-:' Lot Block 16 Contractor Firm Name S - . - RIVER CITY PLUMBING INC. , Street Address N 111 Vista Bldg. 7, D 17 Zip ,, .: 99212 City Spokane State Wa. Phone ( )924-8028 18 Contact Person I License No.. Pud,-.v. Hobeck 1 RIVERCP190KA Phone if different than above - 8 Owner/Agent (if different than 11 above) Business Address 9 Zip City , State Phone 15 Describe Work: New er; Addition/Alteration 0 ; Replace/Repair 0 ' Total Number 7 , , of Fixtures: ( 10 Applicant Name Street Address 11 Zip , City State Phone ( 1 . 9 Bar Sink (8): Drinking Fourttain(s): Floor Dram(s): / 1 WashingMachine(s): / 10 Osh Wshr(s): Garb Disp(s): Kit Sink(s): i / Lndry Tray(s): Sew Eject 0): 11 Urinal (.,): Wtr Closet (s): (--; Lav(s): , Shower (s): / I Tub (s): / Bidet (3): Other: Type; 12 Waste/Grease interceptor(s): 13 Sewer Y N Septic/ Health No.: ; 1 14 Electric Water Ileater(s): / 1 7 Dralris-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 + : 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 perrnit does not presume to give authority to violate or cancel the provisions of any °tiler state of local laws regulating construction or the performance of construction. SIGNATURE OF OWNER OR AGENT. APPLICATION DATE