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 ��