1984, 09-19 Permit App: 00002456 Plumbing Fixtures•
00
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M)
I Department Use Only ms
Tupper Inc .
„(/��s'
Project No. /_
2 Project Address (Not Mailing Address) Space Zip
E. 14725 Olympic
3' City/CommunityI
State
Subdivision/Plat Name
4 Assessor Parcel No. I Lot
Block
16 Contractor Firm Name
John Burke Plmb & Htg
Street Address
P. 0. Box 2691
17 Zip
99220
City
Spokane
State
Wa.
Phone
( ) 535-0066
18 Contact Person
John
License No.
JOHNBPH162JJ
(
Phone if different than above
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work:New IX; Addition /Alteration ❑ ; Replace/Repair ❑
Total Number 12
of Fixtures:
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
L
9 BarSink(s):
Drinking Fountain(s):
Floor Drain (s): 1
Washing Machine(s): 1
10 Dsh Wshr(s):
Garb Disp(s):
Kit Sink(s): 1
Lndry Tray(s):
SewEject(s):
11 Urinal(s):
Wtr Closet (s): 3
Lav(s): 3
I Shower(s): 1 I
Tub(s): 1 I
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:
(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 O
OWNER R AGENT
APPLICATION 9-19-84
DATE