1989, 10-06 Permit App: 89003976 Plumbing Reversal U --". c:::-.) .
PLUMBING PERMIT APPLICATION WORKSHEET
• PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND C3•
e I Owner's Name (71-1-83t> (First) (M) Department Use Only f
s(4 0 Project No.
2 Pr, 26 / O
reqs(Not Mailing Address) SZip •
pace-- 1 y74 /4e./ti
3 City/Community State / Subdivision/Plat Name r
4 Assessor Parcel No. Lot Block
16 Contractor Firm Name - Street Address
RIVER CITY PLUMBING INC. N 111 Vista Bldg. i, $
17 Tip City State Phone
99212 Spokane Wa. t ) 921+-8028
18 Contact Person License No. Phone If different than above
Audrey Hobeck RIVERCP190KA
8 Owner/Agent(if different than M1 above) Business Address
9 bp City Slate Phone '
( )
15 Describe Work: New 0 ; Addition/Alteration tReplace/Repair ❑ Total Number
/
of Fixtures:
I
10 Applicant Name Street Address
11 Zip City State Phone
( I
•
9 Bar Sink(s): Drinking Fountain(s): Floor Drain(s): Washing Machinels):
10 Cash Wshris): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s):
I
11 Urinal(s): 1 Wtr Closet(s): Lav(s): 1 Shower(s): 1 I Tub(s): Bidet(s):
cd Other: Type;
LU
Q
D
V— 12 Waste/Grease Interceptor(s):
X
LL
u- 13 Sever Y N Septic/Health No.:
O
(t
W
a) 14 Elertrlc Water Healer(s): Drains-Root:
D
Z REPAIR OR ALTERATION: Dr at nag ,Vent,Water Piping/Treatment: Y N ///j 1110Y'S/( / r---r`r Imo' a c'UDD
5 5`/77 .r ii'L.. A//../Ii, --r-I4 -11
t6 Lawn Sprinkler System(s),including backflow device on any one meter: iv' 'rc
17 Vacuum beakers 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 ' ; r/" DATE /O — 6 -3 7