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1985, 11-25 Permit App: 00008897 Water Softener 4 'r PLUMBING PERMIT APPLICATION WORKSHEET • PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND Project M 8017 Owner's Name Last First MI BROWN ROD Project Address(Street Name&Number) City State Subdivision/Plat Name Assessors Parcel Lot Blook Plat N - °114 Applicant Address Same S. 1711 Ridgemont Dr. City State Zip Phone Veradale WA 99037 926-5290 Business Phone Contractor Address Soft Water Service Co. E. 25 Thiri City State Zip Phone Spokane WA 99202 455-8050 Contact License M Business Phone Describe Work Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s): Dsh Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s): Urinal(s): WtrCloset(s): Lav(s): Shower(s): Tub(s): Bidet(s): W Other: Type; Water Softener CC XWaste/Grease Interceptor(s): U- IL Sewer Y N Septic/Health No.: O C W m Electric Water Heater(s): Drains-Roof: 2 Z REPAIR OR ALTERATION: Drainage,Vent,Water Piping/Treatment: Y N Lawn Sprinkler System(s),including backf low device on any one meter: Vacuum breakers or backflow devices in excess of line 16:1-5: (00 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 OWNER OR AGENT Soft Water Service Co. DATE