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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