1985, 01-08 Permit App: 00004213 Water Softener •
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M) Department Use Only
KOHN Richard [Project No.
2 Project Address(Not Mailing Address) Space Zip
14802 E. Rockwell AJC. 99216
• 3 City/Community State Subdivision/Plat Name
Spokane WA 1`( lICE)0C O{t NO114 (9f
4 Assessor D Z i Parcel No. 21Qo4 C_K 14 ) I Lot Block
16 Contractor Firm Name Street Address
Soft Water Service Co. E. 25 Third
17 Zip City State Phone
99202 Spokane WA ( 509)455-8050
18 Contact Person I License No. Phone if different than above
8 Owner/Agent(if different than#1 above) Business Address
• 9 Zip City 1 I State Phone
( )
15 Describe Work: New E ; Addition/Alteration El El; Replace/Repair Total Number
of Fixtures:
10 Applicant Name Street Address
11 Zip City State Phone
w •
9 Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s):
10 Dsh Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s):
11 Urinal(s): Wtr Closet(s): Lav(s): Shower(s): I Tub(s): Bidet(s):
Other: Type; Water Softener
I- 12 Waste/Grease Interceptor(s):
L
tL 13 Sewer Y N Septic/Health No.:
O
W
m 14 Electric Water Heater(s): Drains-Roof:
Z 15 REPAIR OR ALTERATION: Drainage,Vent,Water Piping/Treatment: Y N
16 Lawn Sprinkler System(s),including backflow device on any one meter: �j /
17 Vacuum breakers or backflow devices in excess of line 16:1-5: (005+:
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.
2SIGNATURE OF APPLICATION
//8
OWNER OR AGENT ( `-' DATE