HomeMy WebLinkAboutPermit Plumbing 2007-9-28
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225FIITHSTREET _ SPRINGFIELD, OR 97477 - PH:(541)726-3753 -FAX: (541)726-3689
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City Job Numbf'r . I
Job Location {"'04-"\vU:','" G,h \'\J\:_~ ((?u.'-\^-J
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BACKFLOW PREVENTION DEV1CE PERMIT Fa( $61.50 )
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Contractor Information
Contractor
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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.
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For Office Use
Date of Application
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Checked for Delinquencif><:
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Checked for Historical Status
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Shared Drive (T:)/Building Fonns/Backflow Prevention 7-07.doc