1988, 12-08 Permit App: 88003999 Sewer PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
J551 1 2cit 2
e 1 Owner's Name (Last) (First) (M)
//s/, - / Department Use Only
v CO/V f�0 i2 /'�q Project No.
2 Project Address(Not Mailing Address) Space Zip
' / 7-zi //
3 City/Comm nitySlate Subdivision/Plat Name
‘...5-- 4/ w/ I Stam,4_ '
4 Assessor Parcel No. t(/>/� Lot Block
2f2513 - .ts ( _
itie
16 Contractor Firm Name Street Address �
RIVER CITY PLUMBING INC. • _ N 111 Vista Bldg. /' its
17 Zp City . State Phone
99212 _ Spokane _ Wa. - ( ) 924-8028
18 Contact PersonLicense No. Phoneif different than above
Audrey Hobeck l RIVERCP190KA
8 Owner/Agent(if different than Il above) Business Address
9 Zip City State Phone
( I
15 Describe Work: New 0 ; Addition/Alteration 0 ; Replace/Repair Sii� Total Number
��� of Fixtures:
10 Applicant Name Street Address
11 Zp City State Phone
( )
9 Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s):
10 Dah Wshr(s): I Garb Disp(s): Kit Sink(s): I Lndry Tray(s): Sew Eject(5):
11 Urinal(s): 1 WtrCloset p): L.ay(s): 1 Shower(s): I Tub(s): Bidet(s):
N Other: Type;
al
CC.
D
I— 12 Waste/Grease Interceptor(s):
X_
LL
LL 13 Sewer Y N Septic/Health No.:
O
CE 1
W
CO 14 Electric Water Healer(s): Drains-Roof:
Z 15 REPAIR(ALTERATION: Drainage.Vent,)titer Piping/Treatment: Y N
16 Lawn Sprinkler System(s),including backflow device on any one meter:
17 Vacuum breakers or backtlow devices In excess of line 16:1-5: (Or)5+:
a
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 , ./119'
DATE L.Z
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