Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
1986, 01-21 Permit App: 00009434 Plumbing Fixtures
• PLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND IProject# Owner's Name Last // First MI 0:..4ce Project Address(Street Name&Number) �� /Yea( City State Subdivision/Plat Name Assessors Parcel# Lot Block Plat# Applicant Address City State Zip Phone Business Phone Contractor Address Gold Seal MPrhaniral Tiir 5574 F. Rnonc City 1 State Zip Phone Spokane ala 99212 509 535 5944 Contact License# Business Phone R Dixon GO LD SM *290 C4 , Describe Work SFR Bar Sink(s): Drinking Fountain(s): Floor Drain(s): / Washing Machine(s): / Dsh Wahr(s): Garb Diap(s): Kit Sink(s): ' Lndry Tray(s): Sew Eject(s): Urinal(s): WtrCloset(s): Lav(s): y Shower(s): Tub(s): / Bidet(s): Other: Type; I- Waste/Grease Interceptor(s): tL Sewer Y N Septic/Health No.: O � f COElectric Water Heater(s): 1 Drains-Roof: Z REPAIR OR ALTERATION: Drainage,Vent,Water Piping/Treatment: Y N Lawn Sprinkler System(s),including backf low device on any one meter: Vacuum breakers or backflow devices In excess of line 16:1-5: (00 5+: /© ® � 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 overning this type of work, including inspection requirements, will be com- plied with whether specified he ein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions f any other state of local laws regulating construction or the performance of construction. SIGNATURE OF )1111 APPLICATION OWNER OR AGENT DATE