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