1985, 03-08 Permit App: 00004435 Plumbing Fixturese
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PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
t s Name(First) (M)
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Department Use Only
i� 0 w 5 7;
Project No.
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2 Pfolect Address (Not Mailing Address) Space Zip
CS /.. 3 V/2 a. /11/i 5A
3 City/Community
State
Subdivision/ Plat Name
4 Assessor Parcel No.
I Lot
Block
'1-/..gt
16 Contractor Firm Name
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
Audrey Hobeck
I License No.
RIVERCP190KA
Phone if different than above
8 Owner/Agent (If different than 91 above)
' Business Address
9 Zip
City
State
Phone
( )
15 Describe Work: New X ; Addition/Alteration 0 ; Replace/Repair O
Total Number
of Fixtures:
10 Applicant Name
Street Address
11 Zip
I City
State
Phone
( )
9 Bar Sink(s):
Drinking Fountain(s):
Floor Drain (s):/
Washing Machine(s):
10 Dish Wshr(s): /
Garb Disp(s):
Kit Sink (s): /
Lndry Tray(s):
Sew EJect(s):
11 Urinal(s):
WtrCloset(s): 3
Lav(s): 2
Shower(s):
I Tub(s): /
I 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 baddlow device on any one meter:
17 Vacuum breakers or backflow devices in excess of line 16:1-5:
I (00 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 o er - = e of localaws regulating construction or the performance of
construction.
SIGNATURE CATIO
OWNER AGE/�� DATE N''.