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1985, 01-08 Permit App: 00004205 Water SoftenerN W D 7 X X 111 - ILL LL O ccW m z Z PLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND M 1 Owner's Name (Last) (First) NICOLSON, Gerald R. (M) Department Use Only 4 Project No. 2 Project Address (Not Mailing Address) E. 11111 Ponderson Space Z, 96206 3 City/Community Spokane State WA Subdivision/ Plat Name 4 Assessor Parcel No. 6-14 4 2 - 2-6 3o Lpt Block 16 Contractor Firm Name Soft Water Service Co. Street Address E. 25 Third 17 Zip 99202 City Spokane State WA Phone ( 509 ) 455-8050 18 Contact Parson License No. Phone if different than above 8 Owner/Agent(if different than kl above) Business Address 9 Zip City State Phone 15 Describe Work: New ❑ Addition/Alteration ❑ Replace/Repair ❑ Total Number of Fixtures: 10 Applicant Name Street Address 11 Zip City State Phone ( I 9 Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s): 10 Dsh Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Travis): Sew Ejecl(s): 11 Urinal(s): Wtr Closet(s): Levis): Shower(s): Tub(s): Bidet(s): other: Type; Water Softener 12 Waste/Grease Intermptor(s): 13 Sewer V N Septicl Health No.: 14 Electric Water Healer(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 or backflow devices In excess of line 16: 1-5: (Or) 5+: 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 APPLICATION d OWNER OR AGENT Soft Water Service Co. DATE D ��