1986, 07-22 Permit App: 00012364 Plumbing FixturesPLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOeEPARTS OF THE FORM YOU UNDERSTAND
4 1 Owner's Name (First) (M)
/ / (Last)
/lam
Department Use Only
L
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Protect No. '2*e/
2 Project Address (Not Mailing Address) / Space ZIP
/Gi7/7 — /7 /I/orz.4
3 City/CommunityI
State
Subdivision/Plat Name
4 Assessor Parcel No. - I
Lot
Block
16 Contractor Firm Name
RIVER CITY PLUMBING INC..
Street Address
N 111 Vista Bldg. 7, i)
17 Zip '
99212
City
. Spokane
Slate
Wa.
Phone
( )924-8028
18 Contact Person
Audrey Hobeck
License Na.
I'RIVERCP19OKA
Phone 11 different than above
8 Owner/Agent (if Mt lerent Than al above)
Business
Address
9 Zip
City I
State
Plane
15 Describe Work: New 0 ; Addition/Alteration 0 ; Replace/Repair O
Total Number
of Fixtures: 02 Q
10 Applicant Name
Stree Address
11 Zip
City
State
Phone
( )
9 Bar Sink (s):
Drinking Fountain (s):
Floor Drainlsp
Washing Mactnne(s). 2
10 Dsh W,hr(s):
Garb Dtsp(s):
Kit Sink(sl' I Lndry Tray(sl:
Sew Electis):
11 U. -malls):
WI Genal (a): G/
Lavin'L/
l
Shower Is): az
I Tut,(,): 2.
I Bidet
Other: Type;
12 Waste/Grease Inlerceptor(s):
13 Sewer Y N SeptKlHearth No. -
13 Electric Water Heater(s)' %
�!
Drains -Roof'
15 REPAIR OR ALTERATION: Drainage, Vent, Water Piping /Treatment V N
16 Lawn Sprinkler System (s), including backflow device on any one meter:
17 Vacuum breakers 0, backflow devices In excess of line 16:1-5
(0) 54
1S -
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 com-
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 % %2 2 -ff..