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