1986, 07-23 Permit App: 00012261 Water Softener PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
• lqProject#
Owner's Name Last First MI
WINDERS GERALD
Project Address(Street Name&Number)
City State Subdivision/Plat Name
Assessors Parcel# Lot Block Plat#
Lf(g.--(7- /- 7 6
Applicant Address
Same E. 14210 Valleyway
City 1 State Zip Phone
Spokane WA 99216 926-6677
Business Phone
Contractor Address
Soft Water Service Co. E. 25 Third
CityState Zip Phone
Spokane l WA 99202 455-8050
Contact License# Business Phone
Describe Work
Bar Sink(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): Wtr Closet(s): Lav(s): Shower(s): Tub(s): Bidet(s):
Other: Type;
Lu Water Softener
CC
I- Waste/Grease Interceptor(s):
U-
Sewer Y N Septic/Health No.:
O
W
coElectric Water Heater(s): Drains-Roof:
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 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