1986, 09-23 Permit App: 00012234 Plumbing FixturesPLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
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
Project s
Owner's Name Last First MI
PESTRIN, Vic -TO 2 L
Project Address (Street Name & Number)
City
State
Subdivision/ Plat Name
Assessors Parcels
Lot
Block
Plat s
Applicant
Address
Same
S. 1415 Kahuna Dr.
City
State
Zip
Phone
Spokane
WA
-
Business Phone
Contractor
Address
soft Water Servi
City
State
Zip
Phone
Spokane
WA
99202
455.8050
Contact
Licensee
Business Phone
/ � � OZ
5 'fes
Describe Work
BarSink(s):
Drinking Fountaln(s):
Floor Drain Is):
Washing Machine(s):
Dsh Wahr(s):
Garb Disp(s):
Kit Sink(s):
Lndry Tray (a):
Sew Eject(s):
Urinalis):
Wtr Closet (a):
Lav(s):
Shower(s):
Tub(s):
Bidetis):
W
Other: Tye Water Softener
XWaste/Green
Interoeptor(s):
LL
LL
Sewer Y N Septic/ Health No.:
M
W
M
Electric Water Heater is):
Drains -Roof:
Z
REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: Y N
Lawn Sprinkler System(s), including backflow, device on any one meter:
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
OWNER OR AGENT
APPLICATION
DATE