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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