1985, 06-03 Permit: 00005845 Plumbing Fixtures •
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name
Wilt
(Last) /� (First) (M) Department Use Onlyf/���,[��y�✓vtif/
f l / to 4v 5 74. Project No. `'/T'�L�
2 Project Address(Not Mailing Address) ( Spaoe f 4'p
6 V/s" /o 74
3 City/Community 1 State Subdivision/Plat Name
s5A/rAk
4 Assessor Parcel No. Lot Block
16 Contractor Firm Name Street Address
RIVER CITY PLUMBING INC. N 111 Vista Bldg. 7, U
17 Zip City State Phone
99212 _ Spokane Wa. ( ) 924-8326
18 Contact Person License No. . Phone If different than above
Audrey Hobeck RIVERCPi9KA
8 Owner/Agent(if different than ti above) Business Address
• 9 Z City State Phone
( )
Total Number /
15 Describe Work: New ❑ ; Addition/Alteration 0 ; Replace/Repair' ❑
of Fixtures:
10 Applicant Name Street Address
11 Zip City I State Phone
( )
-
f 9 BarSink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s): /
10 Deh Wshr(s): Garb Disp(s): Kit Sink(3): / Lndry Tray(s): Sew Eject(s):
11 Urinal(s): WtrCioset(s): Lav(s): l Shower(s): /j I Tub(s): / Bidet(s):
co Other: Type; /
w
Cr
I— 12 Waste/GreaseInterceptor(s);
X
O13 Sewer Y N Septic/Health No.:
CC
U.' lCO 14 Electric Water Hceter(s): Drains-Root:
�
�
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 devioes in excess of line 16:1-5: (00 5+:
4—U
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 oth:r tate of local laws regulating construction or the performance of
construction.
SIGNATUREOF '• DATE
/ APPLICATION
:
3 -3
OVNER+OR AGENT