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-