1985, 09-27 Permit App: 00008294 Plumbing FixturesUMBING'PERMIT=APPLICATION WORKSHEET.'.
:,PLEASE:.PRINT, AND3COMPLETE.ONLY THOSE PARTS OF,THEFORM YOU UNDERSTAN
1 Owner's Name t - *' .' first -. -
1 �� / gas )'.: '4 /- "' (F ) . IMI
1/✓ U A � /� 47 /✓ N . l CJ /C . . I. -. .
-
Department Use Only . /J
Project No. • " - �.29
2 Project Address (Not Marling Address). .:: . =r!'.. ,space , ZI
' 1 0 7 / 9 d- / it�� r� is .. .
3 City/Community.
State -
Subdivision/Plat Name' .. -
4 Assessor Parcel No. ' - '
iC07tM1.
Lot
Block
-
16 Contractor Firm Name ;'' - . , "-.
:RIVEN .CITY. -PLUMBING -INC!.'..''': =.
Street Address -
N 111 Vista Bldg: 7, D'
99212....
:... State : - ,
Spo.ka.ne . _J__. Wa.' '
Phone - .-
. _ , ( -_ .) 924-8028
. Phone i/ different than above
-IB Canted Person'.:. -:-
Audrey"'Hobeck
-
License No. - .. ". .:. ,i<
RIVERCP190YA';'
8- Owner/Agent (if different than 41 above)
_ „
Business Address ;...', ,
' 9 Zip
City t .
I State
I
Phone
( )
'.15 Describe Work: - New 0 ; Addition/Alteration ❑ ; Replace/ Repair ❑
Total Number n/ ')
of Fixtures: .....L., . „
10 Appllcant Name ,
Street Address
11 Zip ' '
City
State
Phone
9 Bar Slnk(s)'
,&Inking Fountain (s)•
Floor Drain(s):
Washing Machine(s):,
10 Dsh Wshr(s):
Garb Dlsp(s):
Klt Sink(s):• : r2
Lndry Tray(s)
Sewl Eject(s):
•
11 Utinal(s):
Wt Closet(s):.
Lay(s): - :
I Shower(s): • ^']
L•
Tub(s): " I
1
BIde1(s)'
Other: Type; .. " .
12 Waste/Grease Interceptor(s):
13 Sewer - V N. - Septic/ Health No :
14 Electric Water Heater(s):
&ains-Root
15 REPAIR OR ALTERATION: Drainage, Vent, Water Piping /Treatment: ¥ N -
16 Lawn Sprinkler System(s), Including bacidlow device on anyone meter:
' 17 . Vacuum breakers or backflow devices In excess of Zine 16: 1-5: - v -
,
, (Or) 5:4-
1-'certify,that4heatrve;information,assubmitted by.me;is;,trueand porrecYd;,f
anurther;,agree-that ail pro
visions`01 laws`and ordinances governing this type of work, including inspection requirements will be'com-_'_
plied with:whetherspecified'herein• or' not,. The;granting>of a,permit•does not; presume; to'give,authority,to.
violate or cancel the -provisions of any.oth-r's '.te of total laws,regulatleg'construction_or the performance of
risfr
couction.' • •
':SIGNATURE OF::
OWNER:OR.1AGEN