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HomeMy WebLinkAboutPermit Plumbing 1994-8-25 ,- '\"'....~. ~ - " t'"" ,~. '. '..' I. q.'t'" ,.., 1~""1" . fi). 'k~ ':=' / =;/ tl/)i~~:1(i'I?i =/ ~ ~,:',L~ ~~~ :;".;'~ . ,," ~;\iI,iJ)i>1ii\l~i~";;';X .1 .!,,(,;~ ~ll "<J ,'. ' . .'.,'.' ,- BACKFLOWPREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 -------------------------------------------------------------------------------- JOB LOCATION: '70 3 ~ ASSESSORS MAP #: Lts "7- OWNER: '\6 (1/ ~ t.3enT5 ADDRESS: d-..O 0 C (( cGTfl/tPI\J r CITY: 'Stlfl/ L-V'l.l'5 0 r;; I sfo CA. ~ ,./(i-4.. , U ..d6C c:.. t( C#7qY//E /p/tAX LOT #: STATE: PHONE #:--E.05 - <'-l3- Y II S; /"......A ZIP: .23'4 <.) L BACKFLOW PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20 .' CONTRACTOR:. (<.\.~TW~ Pl{,un~(A.lf-..f- 13,{:., ~tLv, ADDRESS: ~ P (). 80 x. 7D~?-ro PHONE #: CITY: 6lA h.f!)-J 0 STATE: OfL- CONSTRUCTION CONTRACTORS REGISTRATION #: Uo, ....-b I / . '-' J..j f/4- 37 <if; 7 ZIP: Cf7'l: () I EXPIRES: 1;)...--/ b -C( tf BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOW PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT. ';", ~ 7"h ~ lLv om I' L ) ~ FOR OFFICE USE DATE OF APPLICATION: 9~2S-9C/ RECEIPT #: I ~ '/5:5 ISSUED BY: TOTAL AMOUNT COLLECTED: /6- . 2c:> '/J JOB #:~;li;~~ /' / ~ ~::?..,---..-.-, . - ~/- -------------------------------------------------------------------------------- \