1986, 12-10 Permit App: 00014476 Water Softener PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
IProject Nlltif
Owner's Name Last First MI
BIRC'GTARD, ,Tnhn A
Project Address(Street Name&Number)
City State Subdiv' on Plat Name
Assessors Parcel# Lot Blook Plat#
2a9/4 - 10 !
Applicant Address
Same E. 15111 12th
City I State Zip Phone
Veradale WA 99037 928-8274
Business Phone
Contractor Address
Soft Water Service Co. E. 25 Third
City State Zip Phone
Spokane WA 99202 455-8050
Contact License# Business Phone
Describe Work
Bar Sink(s):
DrinkingFountain(s): Floor Drain(s): Washing Machine(s):
Dah Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s):
Urinal(s): Wtr Closet(s): Lav(s): Shower(s): Tub(s): Bidet(s):
Other: Type; Water Softener
I- Waste/Grease Interceptor(s):
U-
LL Sewer Y N Septic/Health No.:
O
C
w
LO Electric Water Heater(s): Drains-Roof:
Z REPAIR OR ALTERATION: Drainage,Vent,Water Piping/Treatment: Y N
Lawn Sprinkler System(s),including backflow device on any one meter:
Vacuum breakers or backflow devices in excess of line 16:1-5: (005+:
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
Soft Water Service Co.
OWNER OR AGENT DATE