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1985, 01-08 Permit App 00004208 Wtr SoftenerPLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's Name (Last) (First) (M) PENDERGRASS, Dale A. Department Use Only Project No. �Z7 2 Project Address (Not Mailing Address) Space Zip E. iW19 17020 Broadway 99037 3 City/Community Veradale State WA. Subd ision/Plat N me r 1,,- (144.1- - .>, • t (i L t,,,--- 4 Assessor Parcel No. 1 44 — I o Lot Block 16 Contractor Firm Name Soft Water Service Co. Street Address E. 25 'Third 17 Zip 99202 City Spokane State WA Phone ( 509 ) 455-8050 18 Contact Person License No. Phone if different than above 8 Owner/Agent (if different than #1 above) Business Address 9 Zip City State Phone ( ) 15 Describe Work: New ❑ ; Addition/Alteration C ; Replace/Repair 7 Total Number of Fixtures: 10 Applicant Name Street Address 11 Zip City State Phone 1 ) 9 BarSink(s): Drinking Fountain(s): Floor Drain(s): Washing Machine(s): 10 Dsh Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): Sew Eject(s): 11 Urinal(s): Wtr Closet (s): Lav(s): Shower(s): Tub(s): I Bidet(s): Other: Type; Water Softener 12 Waste/Grease Interceptor(s): 13 Sewer Y N Septic/Health No.: 14 Electric Water Heater(s): Drains -Roof: 15 REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: Y N 16 Lawn Sprinkler System(s), including backflow device on any one meter: 17 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 OF Soft Water Service Co. APPLICATION OWNER OR AGENT DATE i/gAs'