1986, 03-07 Permit App 00009913 Wtr Softener4.
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
/ ts K_ 1
Project # i /3
l'
Owner's Name Last First MI
EDGERLY, Dan
Project Address (Street Name & Number) A l_r 1 C l e
City
State
Su ision/ Plat Name /4 ,_
j
Assessors Parcel #
/�553 -- //
Lot
I
Block
/
Plat*
Applicant
Same
Address
E. 1721E Broadway
City
apakGreenacres
State
( ':JA
Zip
99016
Phone
922-0385
Business Phone
Contractor
Soft Water Service Co. I
Address
E. 17216 Broadway
City State
Spokane 1WA
Zip <]2
99ii
Phone 455-8050
Contact
License #
Business Phone
Describe Work
Bar Sink(s):
Drinking Fountain(s):
Floor Drain(s):
Washing Machlne(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):
Other: Type; Water Softener
J
C
D
- Waste/Grease Interceptor(s):
C_
L
I- Sewer Y N Septic/Health No.:
C
0 Electric Water Heater(s):
Drains -Roof:
)
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.
APPLICATION
DATE
SIGNATURE OF
Soft '.~later Service Co.
OWNER OR AGENT