1984, 09-06 Permit App: 00001969 Water SoftenerPLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M) J Department Use Only L
! Li (���
K P5RK David Protect No
2 Project Address (Not Mailing Address) Space Zip
18320 E. Maxwell 99016
3 City/ Community Spokane State
WA
Subdivision/Plat Name 1
)
Vg-'iQC1 ViEGuc9(lrl
4 Assessor Parcel No.
/855/- 23/1
I Lot
Block
16 Contractor Firm Name
Soft Water Service Co.
Street Address
E. 25 Third
17 Zip
99202
City
Spokane
State
WA
Phone 455—S0 0
(509 )t8�8
18 Contact Person
License No.,_Phone
5orTWkge//a 62-
If different than above
8 Owner/Agent (If different than 41 above)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work: New ] Addition/Alteration ❑ Replace/Repair ❑
Total Number
of Fixtures;
10 Applicant Name
Street Address
11 Zip
City
State
Phone
1 )
9 Bar Sink(s);
Drinking Fountain(s):
Floor Dram(s):
Washing Machine(s)-
10 Dsh Wahr(s):
Garb DIsp(s):
Kit Sink(s):
Lndry Tray(s):
Sew Eject(s):
11 Urinal(s):
Wt Closet(s):
Lav(s):
I Shower(s);
Tub(s).
Bidet(s)-
Other: Type; Water Softener
12 Waste/Grease Interceptor(s): -
13 Sewer V 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 18: 1-5.
I (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 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 Soft Water Service Co. APPLICATION
OWNER OR AGENT DATE