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HomeMy WebLinkAboutPermit Plumbing 1999-8-27 BACKFLOW PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50 CONTRACTOR: ~~ r~~.' ADDRESS: ;l/ff) J~~i/n(I~ ". PlaNE #: ,7q!-~/J()7(~ CITY: h ~fl<!- J .' J - I STATE: ~~"'^- ZIP: 97~O 3 CONSTRUCTIO~ ~N;RACTORS ~ISTRATION fi:: (fi ~Q 0 . EXPIRES: (/ / tJ7.) I BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOW PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR I~SPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/ApPLICATION IS CORRECT. Li?,j)/ / SIGNATURE ~ /' DATE FOR OFFICE USE ::::-::-:~~::::::::~-~~J~~ji-~-~--~-------------------:::-:~--~~-(;--~-~-~ RECEIPT fi::'O~53 & tL; f ISSUED BY:/? [)]tlCha d 0 TOTAL AMOUNT COLLECTED: ( (tt ) ( IJ ' ,~ . ,--.. ... - --------------"------------------------------------------------------------------