1984, 05-11 Permit App: 00001970 Water Softener 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 /07?)
Dunham Pat Project No.
2 Project Address(Not Mailing Address) Space Zip
E. 6808 - 11th 99212
3 City/CommunityState Subdivision/PIgt Name
Spokane ) WA (00(6 C`e /S t A c1c/
4 Assessor Parcel No. Lot Block
z(/f� 2662— 12-
16 Contractor Firm Name Street Address
Soft Water Service Co. E. 25 Third Ave.
17 ZipCity State Phone
99212 I Spokane WA ( 509 ) 455-8050
18 Contact Person License No. Phone if different than above
8 Owner/Agent(if different than Al above) Business Address
•
9 Zip City State Phone
15 Describe Work: New X ; Addition/Alteration ❑ Total Number Replace/Repair ❑ of Fixtures:
10 Applicant Name Same Street Address
11 Zip City State Phone
( 509 ) 922-5958
9 Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s):
10 Dsh Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s):
I11 Urinal(s): Wtr Closet(s): Lav(s): Shower(s): I Tub(s): Bidet(s):
Other Type: Water Softener
cc
X12 Waste/Grease Interceptor(s):
LL
LL 13 Sewer Y N Septic/Health No.:
O
cc
W
m 14 Electric Water Heater(s): Drains-Roof:
Z 15 REPAIR OR ALTERATION: Drainage,Vent,Water Piping/Treatment: Y N
16 Lawn Sprinkler System(s),including backf low device on any one meter:
17 Vacuum breakers or backflow devices in excess of line 16:1-5: (Or)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
OWNER OR AGENT Soft Water Service Co. DATE 5/11/84