1986, 03-27 Permit App: 00010235 Plumbing Fixtures•
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PLUMBING PERMIT APPLICATION WORKSHEET
• " -- -PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1
1 Ow Name 1 (Leat) (First) (M)
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Department the Only - I
Project No. /0
2 Project Address (Not Mailing Address( Space Zip -
3 City/Community IState
Subdivision/ Plat Name
4 Assessor Parcel No.
I Lot
E{I
Block
16 Contractor Firm Name
RIVER CITY PLUMBING INC.
Street Address
N 111 Vista Bldg: 7, D
17 Zip
99212
City
-: , Spokane
State
. Wa.
I Phone
( ) 921i.-8028
18 Contact Person i License No,
e Audrey Hobeck 1 PIVERCP190KA
Phone if different than above
8 Owner/Agent (11 different than #1 above) 11 j Business
Address
9 Zip
City
State
Phone
I )
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15 Describe Work: New l� ; Addition/Alteration ❑ Replace/ Repair 0
Total Number /�
of Fixtures:
10 Applicant Name -
Street Address
11 Zip
City
Stale
Phone
9 Bar Sink(s):
Drinking Fountain (s):
Floor Drain (s):
j
Washing Machine(s): /
10 Dish Wshr(s):
Garb Disp(s):
KIt Sink(s): /
Lndry Tray (s) 1Sew Eject(s):
I
11 Urinal(s):
Wtr Closet (s): ✓^,
Lav(s): S
j
I Shower(s): % I
1
Tub(s): /
Bidetis):
Other: Type;
12 Waste/Grease Interceptor(s):
1:., hewer Y N Septicl Health No.: •
14 Electric water Neatens): /
f Drains -Roof:
15 REPAIR OR ALTERATION: Drainage, Vent, Water Piping /Treatment: V 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:
(00 5+:
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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 oyer state of local,ws regulating construction or the performance of
construction.
C
SIGNATURE OF
OWNER OR_AGENT_
r
APPLICATION
DATE
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