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1985, 11-20 Permit App: 0008819 Water Softener L.� �4g - cc) i4 f PLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1Project# Owner's Name LastFirst MI CHOATE M, ' Project Address(Street Name&Number) State Subdivision/Plat Name ` � � City 1-1 I✓L. , Block Platff Assessors Parcel# Lot -Z7 5 4 ,3 — O Co il Address Applicant E. 12715 Sk iew Same Zip Phone City State 924-3958 99216 e,�, _a- WA Business Phone Address Contractor E. Is Soft Water Service Co. Zip Phone State City Spokane WA 99202 455-8050 Business Phone License#Contact Describe Work 1 Washing Machine(s): Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Dsh Wahr(s): Garb Dlap(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s): Wtr Closet(s): Lav(s): Shower(s): I Tub(s): Bidet(s): Urinal(s): v7 Other: W Type; Water Softener cc o I— Waste/Grease Interceptor(s): X Li u_ Sewer Y N Septic/Health No.: O IL Drains-Roof: m Electric Water Heater(s): 2 D Z REPAIR OR ALTERATION: Drainage,Vent,Water Piping/Treatment: Y N Lawn Sprinkler System(s),including backflow device on any one meter: I (Or)5+: Vacuum breakers or backflow devices in excess of line 16:1-5: I certify that the above information as submitted by me is true and correct further, t all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied m- vi h whether specified herein ortpresume give violate or cancel the provisions of any her state of local laws regulating construction or the performance of construction. APPLICATION SIGNATURE OF Soft Water Service Co. DATE OWNER OR AGENT