1985, 02-15 Permit App: 00004238 Water Softenerw
r. G rf 5 2 �1 - 443
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF TH,E FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M)
Department Use Only
'8
STEMM Mike
Project No. II--
2 Project Address (Not Mailing Address) Space Zip
S- 2603 nnra nn_ 99037
3 City/Community
Veradale
I State
WA
Subdivision/Plat Name
..,,._L) i i 6Lotiok.
4 Assessor Parcel
2593
No.
-D� or
Lot
Block
2
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 Person
License No.
Phone if different than above
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
15 Describe Work: New E3 CI; Addition/Alteration ❑ ; Replace/Repair
Total Number
of Fixtures:
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
9 BarSink(s):
Drinking Fountain(s):
Floor Drain (s):
Washing Machine(s):
10 Dab Wshr(s):
Garb Disp(s):
Kit Sink(s):
Lndry Tray (s):
Sew Eject(s):
11 Urinal(s):
Wtr Closet (s):
Lav(s):
Shower(s):
1 Tub(s):
Bidet(s):
Other: Type; Water Softener
12 Waste/Grease Interceptor(s):
13 Sewer Y N Septic/Health No.:
14 Electric Water Heater(s):
Drains -Roof:
15 REPAIR OR ALTERATION: Drainage, Vent, Water Piping /Treatment: Y 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:
(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 Servciee DATE 2/15/85