1987, 01-29 Permit App: 87000214 Water Softener PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
q2-X X35
IIProtect# + /
Owner's Name Last First MI
Grub William -
Project Address(Street Name&Number)
City State Subdivisio`/PI t Name
tG-4.1 [S
Assessors Parcel# Lot Block( Plat#
335112. — 32O
Applicant Address
Same S. 3806 Woodward
City State Zip Phone
Spokane WA 99206 455-8050
Business Phone
Contractor Address
Soft Water Service Co. E. 25 Third
CityState Zip Phone
Spokane 1 WA 99202 455-8050
Contact License# Business Phone
Describe Work
Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s):
Deh Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s):
Urinal(s): Wtr Closet(s): Lay(s): Shower(s): Tub(s): Bidet(s):
Cl) Other: Type: Water Softener
cc
I- Waste/Grease interceptor(s):
LL Sewer Y N Septic/Health No.:
O
CCW
_CO 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: (00 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