1989, 04-07 Permit App 89001203 Plumb Fixturer765 6
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
As
1 Owner's Name (L t) (First) (M)
Department e Only
th
/J
C%' C.C/ A �S 42. r
Project No.
2 Project Address (Not Mailing Address) Space Zip
S 2//2 /°iAy�s
3 City/Community
State
Suodivion/ Name
4 Asaelabr Parcel No. (
22.5i/2 - /125
Lot
Block
16 Contractor Firm Name
RIVER CITY PLUMBING INC.
Street Address
N 111 Vista Bldg. ¥, 9
17 Zip
99212
CIty .
Spokane
State
Via.
Phone
( ) 924-8028
18 Contact Person
Audrey Hobeck
I License No.
RI9OKR
Poe»It different Than above.
8 Owner/Agent(il different than 01 above)
Business
Address
9 ZIP
City
Slate
Phone
^
15 DescribeWork: New 0 Addition/Allegation ll"-:' FieDlade/ReDef Total Number
ir
ofFixtures: /
10 Applicant Name
Slree Address
11 2ip
City
Slate
Phone
( )
9 Bar Sinh(s):
Drinking Fountain(s):
Floor Orain(s):
Washing Machine(s):
10 Ceh Wsnrts):
Garb Disp(s):
Kit Sinklsl:
Lndry Tray (s):
Sew Eject i5): /
11 tyinal(s)-
WI Closet (s):
Lay (a):
Shower (s):
Tub(s):
&dells):
Other: Type;
12 Waste/Grease intercepior(s):
13 Sewer Y N Septic/lifxgllh No.:
14 Ekitric Water MealHis):
Drains -Roof'
15 REPAIR OP ALTERATION: Drainage, Vent, Water Piping/Treatment: Y N
16 Lawn Sprinkler System(s), including backflow device on any one meter:
17 Vacuum beakers or baktlow devbes In excess of line 16:1-5:
((DOS.:
1 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, 7
SIGNATURE OF �� APPLICATIO j