1985, 11-08 Permit App: 00008633 Plumbing Fixtures 4'
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 Fie;: )--3
�f
T i l e,- F/'—efJ. Project No.
2 Project Address(Not Mailing Address) Space Zip
E . /obis 9-c4',
3 City/Community 1 State Subdivision/Plat Name
4 Assessor Parcel No. e Lot Block
16 Contractor Firm Name Street Address
SNAPPY PLUMBING, IN C. N. 7520 Market St.
• 17 ZipCity State Phone
99207 I Spokane Washington ( > 467-8428
18 Contact Person I License No. Phone if different than above
SNAPPI-222DZ
8 Owner/Agent(if different than#1 above) Business Address
• 9 Zip City I State Phone
( )
15 Describe Work: New ElAdditionlAlteration 1:1ReplacelRepair ❑ 7 Total Number r
�of Fixtures:
10 Applicant Name Street Address
11 Zip City State Phone
( )
* *
9 Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s):
•10 Dsh Wshr(s): Garb Disp(s): Kit Sink(s): J Lndry Tray(s): f Sew Eject(s): 6
11 Urinal(s): Wtr Closet(s): l Lav(s): / Shower(s): ) Tub(s): Bidet(s): xi
co Other: Type; 244W
cc
D r�
X12 Waste/Grease Interceptor(s): r V
LI
W 13 Sewer Y N Septic/Health No.: �r
O
M
W
CO 14 Electric Water Heater(s): Drains-Roof:
2
n
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+:
34 `
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
OWNER OR AGENT ( DATE I^ —yr