1986, 05-09 Permit App: 00010936 Water SoftnerN
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PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THEFORM YOU UNDERSTAND
fproiect#
Owner's Name Last First MI
HARGROVE Robert
Project Address (Street Name & Number)
City
State
Subdivision/ Plat Name
Assessors Parcel #
Lot
Block
Plat #
Applicant
Robert Hargrove
Address
N. 1117 St. Charles
City
Veradale
I State
WA
Zip
99037
Phone
92_6-4854
Business Phone
Contractor
Soft Water Service Co.
Address
EJ 25 Third
City
Spokane
1 State
WA
Zip
99202
Phone
455-8050
Contact
License #
Business Phone
Describe Work
BarSink(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):
Other: Type; Water Softener
Waste/Grease Interceptor(s):
Sewer Y N Septic/ Health No.:
Electric Water Heater(s):
Drains -Roof: —
REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: Y N
Lawn Sprinkler System(s), including backflow device on any one meter:
Vacuum breakers or backflow devices in excess of line 16: 1-5:
(Or) 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