1986, 04-14 Permit App: 00010491 Plumbing Fixtures s
;t, PLUMBING;PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 owner's Name (Last) " •� �-" '' (First)•_ (M)` Department Use Only --
' ` C /s` (
/ l 0i J Project No. /} t"/
2 Project Address(Not Mailing Address) Space Zip
(• 14, 37`r}
3 City/Community State" - Subdivision/Plat Name
4 Assessor Parcel No. Lot Block
•
16 Contractor Firm Name
Street Address
RIVER CITY PLUMBING INC. N 111 Vista Bldg. 7, D
17 Zip City State
Phone - .
99212 Spokane ' Wa. ... V -,) 924-8028 :
: 18 Contact Person> License No. ' Phone if_ �?n C�fterent;" ab vg ,-7 ss.
Audrey Hobeck RIVERCP`I9OKA � ,
8 Owner/Agent(if different than#1 above) ,_,,, , Business Address ,, - Fa 14.:;_„ :4^''.:?;-i.-,_
9 Zip City State Phone
( )
-
15 Describe Work: New 0 ; Addition/Alteration 0 ; Replace/Repair. ❑ Total Number /
of Fixtures: /
10 Applicant Name
Street Address
( , )
*
9 Bar Sink(s): Drinking Fountain(s): Floor Drain(s): • Washing Machine(s): q
10 Dsh Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s):
11 Urinal(s): WtrCloset(s): �1 Lav(s); `
p` (s)• Tub(s): � � Bidet(s):
W
Other: Type;
CC
I- 12 Waste/Grease Interceptor(s): •
ti
O 13 Sewer Y N Septic/Health No.:
CCW
' M 14 Electric Water Heater(s): a Drains-Roof:
2 •
Z 15 REPAIR OR ALTERATION: ,• Drainage,Vent,Water Piping/Treatment:- Y N
16 lawn Sprinkler System(s),including backflow device on any one meter:
17. Vacuum breakers or backflow devices in excess of line 16:1-5: (Or)5+:
't Ly« r ,s•-,•,,,•,..<.«,„ „,,,,,,,..,„, .„..,,:,,,..4.•,..4,•,Q.!•-••.,,----,----:. ”-' • Fy`F'' ' ti''''s`" 9 to
I certify that the above information as submitted by me is true and correct and further, agree that alt pro-
visions'of laws and ordinances-governing this-type of,work;-including inspection requirements,Will`be'coin- ': ;'
;plied with whether specified_herein.or not4-The granting ofa;permit does•not resume to
^: p give authority to
violate or cancel the provisions of any other state of local suiatipg constructionor{the performance-of.
construction.
SIGNATURE OF! '_
.„...;.2,2_,';;;:..,-.,.— x ` APPLICATION j
I' ___,7‘...., j
OWNER OR AGENT - sk51 - -
st, KA . =! i ->
x^, .-: -,-: .p+ rs r r rr.YLY17a Jf