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.
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SIGNATURE ~
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DATE
FOR OFFICE USE
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RECEIPT fi::'O~53 & tL; f ISSUED BY:/? [)]tlCha d 0
TOTAL AMOUNT COLLECTED: ( (tt ) ( IJ ' ,~ .
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