1987, 06-15 Permit App 87001887 SewerPLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Last) (First) (M)
Department Use Only
1 Owner's Name
Fryhlinq Dorothy E.
Project No.
2 Project Address (Not Mailing Address) Space Zip
E. 12318 Mission, Spokane, Washington 99216
3 City/Community
State
Subdivision/Plat Name
4 Assessor Parcel No. /y
1 l _ 0-/ a
L
Lot
I
Block
16 Contractor Firm Name
Miller's Plumbing
Street Address
E. 623 Liberty
99207 I 17 Zip
City
Spokane
State
Wash.
Phone
( 509 ) 483-2025
18 Contact Person
David or Rosie Miller
License No.
MILLESP214BK
Phone if different than above
8 Owner/Agent (if different than #1 above)
Business
Address
I. 9 Zip
City
State
Phone Owner' s/Job Phone: --
( 509) 926-3920
15 Describe Work: New ❑ ; Addition/Alteration X ;
Replace/Repair
Total Number N/A
of Fixtures:
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
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):
Bidet(s):
J Other: Type;
12 Waste/Grease Interceptor(s):
C
13 Sewer [ Y ] N Septic/HealthNo.: SEWER HOOK—UP
C
iJ
fl 14 Electric Water Heater(s):
Drains -Roof:
D
Z 15 REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: [ Y ] N RE: BASEMENT/DRAINAGE ALTERATION
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+:
(Replace/Repair/Alteration) MINIMUM PERMIT FEE DUE...TOTAL PERMIT FEE:
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
OWNER OR AGENT
20.00
APPLICATION
DATE 06-15-87