1985, 11-25 Permit App: 00008899 Water Softener F a • y
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
IProject k 4)0,G�
Owner's Name Last First MI
FARMER JACK W
Project Address(Street Name&Number)
City State Subdivision/Plat Name
Assessors Parcel# Lot Block Plat#
`F2 - 19P
—
Applicant Address
SAME S. 715 Vercher
City I State Zip Phone
Spokane WA 99216 926-4466
Business Phone
Contractor Address
Soft Water Service Co. E. 25 Third
City State Zip Phone
Spokane WA 99202 455-8050
Contact License# Business Phone
Describe Work
Bar Sink(s): Drinking Fountaln(s): Floor Drain(s): Washing Machine(s):
Dsh Wshr(s): Garb Dlap(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s):
Urinal(s): WtrCloset(s): Lav(s): Shower(s): Tub(s): Bidet(s):
w Other: Type; Water Softener
cc
XWaste/Grease Interceptor(s):
U-
O
Sewer Y N Septic/Health No.:
CC
W
m Electric 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
Soft Water Service Co. .
OWNER OR AGENT DATE