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1986, 07-22 Permit App: 00012366 Plumbing Fixtures• ;1 PLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name (Last) (First) IM) moo 0 / Department Use Only Y ,/// / K o /� N A' c (� O jc Project No `2 ZO‘ 2 Project Address (Not Mailing Address) �,r Space Zip /O BOJ —o�3 A/o:re A 3 City/Community I State Subdivision/Plat Name A Assessor Parcel No. I lot Block 16 Contractor Firm Name RIVER CITY PLUMBING INC. Street Address N 111 Vista Bldg. 7, D 17 Zip 99212 I City I Spokane Stale Wa. Phone ( 1924-8028 18 Contact Person Audrey Hobeck License No. No. I RI 90KA Phone it different than above 8 Owner/Agent Of different than 1/1 above) Busy ess Address 9 Zip Gty I State Phone ( ) 15 Dasctibe Work: New 0 ; Addition/Alteration 0 ; Replace/Repair ❑ Total Number of Fixtures: 0.2 O 10 Applicant Name Street Address 11 Zip City State Phone 9 Bar Sink(s): Oinking Fountain(s): Floor Orem (s): ) Washing Machine(s) c2 10 Olh Wshr(s) Garb Deets: KII Sink (s) e2 Lndry TraYbl. I Sew Elecgs l' 11 Urinal(])' Wt Closet Ls): Lav(s) y Showers) 2.. I Tubs) I Bidet tsl ii Other: Type; 12 Waste/Grease Interceptor(sh 13 Sewer Y N Sephcl Hearth No - 14 Electric Water HeaterIs) eZ Drains -Roof - 15 REPAIR OR ALTERATION- Drainage, Vent, Water Piping/ Treatment V N 16 Lawn Sprinkler System(s), Including backtlow device on any one meter: 17 Vacuum beakers o backflow devices In excess al tine 16- 1-5 (D-) 5.. QS- (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 corn - 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 ) - z1 �S-