HomeMy WebLinkAbout1985, 08-27 Permit App: 00007174 Plumbing Fixtures ti •
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PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
IProject# .7 I, 7
Owner's Name Last First MI �7L
Project Address(Street Name 8 Number)
lto �
City State Subdivision/Plat Name
Assessors Parcel# Lot Block Plat#
Applicant Address
City State Zip Phone
Business Phone
Contractor Address
Gold Seal Mechanical, Inc 5524 E Boone
City State Zip Phone
Spokane Wa 99212 509 535 5944
Contact License# Business Phone
R Dixon GO LD SM *290 C4
Describe Work
SFR
Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s):
Dsh Wshr(s): i Garb Disp(s): Kit Sink(s): 1 Lndry Tray(s): Sew Eject(s):
Urinal(s): WtrCloset(s): Lav(s): ' Shower(s): Tub(s): / Bidet(s):
O Other: Type;
CC
XWaste/Grease Interceptor(s):
LL
W Sewer Y N Septic/Health No.:
O
W
CO Electric Water Heater(s): Drains-Roof:
2
Z 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 submiy me is tide anc}Vcorrect and further, agree that all pro-
visions of laws and ordinances governingistTi 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 - f DATE g S'5