1984, 09-19 Permit App: 00002418 Plumbing Fixtures 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 1E
Tupper Inc . Project No. ��-
, .
2 Project Address(Not Mailing Address) Space Zip
E. 14825 Wabash Ct . 9.c %F.,f CI
3 City/CommunityState Subdivision/Plat Name
4 Assessor Parcel No. I Lot Block
16 Contractor Firm Name Street Address
John Burke P & H P. 0. Box 2691
17 Zip I City State Phone
99220 Spokane Wa. 535(-0066
18 Contact Person I License No. Phone if different than above
John JOHNBPH162JJ
8 Owner/Agent(if different than#1 above) ' Business Address
9 Zip City State Phone
( )
15 Describe Work: New ❑k; Addition/Alteration D ; Replace/Repair ❑ Total Number I F 1
of Fixtures:
10 Applicant Name Street Address
11 Zip City State Phone
( )
* *
9 Bar Sink(s): Drinking Fountain(s): Floor Drain(s): 1 Washing Machine(s):
10 Dsh Wshr(s): Garb Disp(s): Kit Sink(s): 1 Lndry Tray(s): Sew Eject(s):
11 Urinal(s): Wtr Closet(s): 3 Lay(s): 3 Shower(s): 1 Tub(s): 1 Bidet(s):
u) Other: Type;
W
CC
D
I- 12 Waste/Grease Interceptor(s):
LL
LL
O 13 Sewer Y N Septic/Health No.:
W
CO14 Electric Water Heater(s): 1 Drains-Roof:
D
Z 15 REPAIR OR ALTERATION: Drainage,Vent,Water Piping/Treatment: Y N
16 Lawn Sprinkler System(s),including backflow device on any one meter:
tit/17 Vacuum breakers or backflow devices in excess of line 16:1-5: (005+:
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-19-84
OWNER OR AGENT DATE