1986, 07-22 Permit App: 00012365 Plumbing Fixtures. PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINTAND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
.t,
1 Owner's Name (Leal) (Plot) (M)
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Department Use Only
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✓✓ a it /v �% /✓ ( - (J K rJ
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Protect No. / 2e, S
_ 2 Project Address (Not Mailing Address) Space ZIP
/0 10 9 —1, WO n A
3 CitylCommunity - - I
State
Subdivision/ Flat Name
4 Assessor Parcel No. -
Lot
BIock
16 Contractor Arm Name
RIVER CITY PLUMBING INC.
Street Address
N 111 Vista Bldg. 7, 1J
17 Lp
99212
I City ,
1 Spokane
State
Via.
Phone
( 1924-8028.
18 Contact Person
Audrey Hobeck
License No.
RIVERCP190KA
Phone If different than above
8 Owner/ Agent Of different than 41 above)
Business
Address
9 ZIP
City
I State
Phone
15 Describe Work: New O; Addition/Alteration O: Replace/Repair O
Total Number --s
of Futures: d O
10 Applicant Name
Street Address
11 ZIP
City
State
Phone
1 )
9 Bar Sink(,)'
DrInking Fountain (5)-
Floor Dram(s):
02_
Washing Machine(s):
10 Lbs wahr(a):
Garb Dlsp(s):
Klt Sink (5): .2 I Lndry Tray(' t: I SewElect(s)-
11 Urinal (a):
WI Clonal (5)- //
/�j
Lav(s)'
Sfwwer(s)' cz
I Tubs)
I Bidet(s)
Other: Type;
11 Waste/Grease Interceptor(s).
13 Sewer Y N Sept¢/Health NO.'
1t Electric Water Healer(s) cQ
Orains-Roof-
15 REPAIR OR ALTERATION Drainage. Vent, Water Piping/Treatment Y N
16 Lawn Sprinkler System (s), Including backflow device on any one meter'
17 Vacuum breakers or backflow devices In excess of tine 16:1-5:
(Cr)5a'
vi -
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 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 7-d-. —d c.