1986, 07-22 Permit App: 00012362 Plumbing Fixtures•
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name t (First) (M)
Department Use Only
U/ /p_���fffJ eGhi
W
Project No. ize1z
2 Project Address (Not Mailing Address) Space Zip
/oya3 - a2 A/00,n
3 CitylCommunity
I State
Subdivision/Plat Name
4 Assessor Parcel No.
I Lot
Block
16 Contractor Firm Name
RIVER CITY PLUMBING INC.
Street Address
N 111 Vista Bldg. 7, D
17 Zip
99212
1 City
I Spokane
State
Wa.
Phone
( )924-8028
18 Contact Person
Audrey Hobeck
1
License No.
RIVERCP190KA
Phone if different than above
8 Owner/Agent (if different than 41 above)
+
Business
Address
9 Zip
City
1
I State
Phone
( )
15 gibe Work: New 0 ; Addition/Alteration 0 ;
Replace/Repair ❑
Total Number
01 Fixtures: 0
07
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
9 Bar Sink(s):
Drinking Fountain (s):
Floor Drain(s): -._
Washing Machine (s):
10 0th Wshr(s):
Garb Disp(s):
K11 Sink(s):
Lndry Tray(s):
l Sew Eject(s):
11 Urinal(s):
Wt closet 0):
Lav(s): G/
Shower(s):
Tub(s):
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(5), including backflow device on any one meter:
17 Vacuum breakers or backtlow devices In excess of line 16:1-5:
(Or) 5 + :
4
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
OWNER OR AGENT
APPLICATION 2
DATE