1985, 02-15 Permit App: 00004226 Water Softener4.
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
13000
1 Owner's Name (Last) (First) (M)
Department Use Only
MOFFITT Hal A
Project No ,1'f 2-
2 Project Address (Not Mailing Address) Space Zip
S. 1715 McDonald 99216
3 City/Community State
Spokane WA
Su ision/Plat Name/ / �j
U[% OY7Z(Nrifi /-f'r`o Lr e
4 Aamysor Parcel No
Z75S1/- /Q20
Lot
zo
Block J
5
/
16 Contractor Firm Name Soft Water Service Co.
Street Address E. 25 Third
17 ZipCity
99202
Spokane
State
WA
Phone
( 509 ) 455-8050
18 Contact Person I
License No.
Phone if different than above
8 Owner/Agent (If different than 41 above)
Business Address
9 Zip
City
I State
Phone
( )
15 Describe Work: New Li, Addition/Alteration C , Replace/Repair LITotal
Number
of Fixtures
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
9 Bar SInk(s):
Drink! g Fountain(s):
Floor Drain(s)
Washing Machine(s)-
10 Dsh Wshr(s):
Garb Dlsp(s):
Kit Sink(s)
Lndry Tray is):
Sew Eject(s):
11 Urinal(s):
Wt Closet(s):
Lav(s):
I Shower(s).
I Tubls).
Bidet(s):
Water Softener
Other: Type;
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 16' 1-5
1005+ :
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
APPLICATION
OWNER OR AGENT Soft Water Service Co. DATE 2/15/85