1984, 09-19 Permit App: 00002438 Plumbing FixturesPLUMBING PERMIT APPLICATION WORKSHEET
• PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
•
1 Owner's Name (Last) (First) (M)
Department Use Only ��
Tupper Inc.
Project No.
2 Project Address (Not Mailing Address) Space Zip
E. 14622 Olympic
3 City/Community
I State
Subdivision/Plat Name
4 Assessor Parcel No.
1 Lot
Block
18tr or Firm Neale
Join Burke P & H
Street Address
P. 0. Box 2691
r 17 Zip
99220
City
Spokane
State
Wa
Phone
5(35-0Q66
18 Contact Person
John
License No.
JOHNBPH162JJ
Phone if different than above
8 Owner/Agent (If different than 41 above)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work: New gt ; Addition/Alteration 0 ; Replace/Repair CITotal
Number
of Fixtures:
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
9 Bar Sink(s):
Drinking Fountain(s):
Floor Drain (s):
Washing Machine(s): 1
10 Dsh Wshr(s):
Garb Diap(s):
Kit Sink(s): 1
Lndry Tray(s):
Sew Eject(s):
11 Urinal(s):
WtrCloset (s)5
J
Lay(s): 3 I
Shower(s): 1
I Tub(s): 1
Bidet(s):
Other: Type;
12 Waste/Grease Interceptor(s):
13 Sewer Y N Septic/Health No.:
14 Electric Water Heater(s): 1
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:
(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 other state of local laws regulating construction or the performance of
construction.
SIGNATURE OF
OWNER OR AGENT
APPLICATION
DATE 9-19-84
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