1986, 11-17 Permit App: 00014202 Water Softener /2.000
PLUMBING PERMIT APPLICATION WORKSHEET A-S
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
IProject M ,112.
Owner's Name Last First MI
THOMAS Ralph H
Project Address(Street Name&Number)
City State SubQiOiiion/Plat N�
UPp 2&i'
Assessors Parcel# Lot Blook Plat#
Applicant Same Address E. 12502 16th
City 1 State Zip Phone
Spokane WA 99216 926-5680
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):
Drinking Fountain(s): Floor Drain(s): Washing Machine(s):
Dsh 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):
LU Other:
w Type; Water Softener
Ir
I- Waste/Grease Interceptor(s):
U-
tL Sewer Y N Septic/Health No.:
O
CCw
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: (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 OFAPPLICATION
Soft Water Service Co.
OWNER OR AGENT DATE