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
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Department Use Only - _, •,•,- ..-••=...;,_ .
No
2 Project Acidreqs (N9t Mailing . Space Zip
/.-•7;'"- x
,
Cityli, e • , ' '1.
3 rS'tate
Subdivision/ Plat Narne
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:::, , :•., .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