HomeMy WebLinkAboutPermit Plumbing 1998-8-19
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SPRINGFIELD
BACKFLOY PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
JOB LOCATION: /68 7$"7'1" S-/
ASSESSORS MAP jl: /1 t; '1- $ S~ 00
TAX LOT jl: 0 J~l)(
OIINER:
ATTENTION:Oregon law requires you to
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Notification C8fJtmNIhll~e rules ~re set fo~h
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cMQ;nCE: STAWB90. You may obtain copies of t~fpyles by
THIS PERMIT SHALL EXPIRE IFTHE WORK calling tnecemer. \IW"".'~'" ," ~~h~.:v
number for the Oregon Ulthty NoltflcatlOn
~~K~gwzlplE~ijs~ff0u.,m: IS NOT (STATE SURCHARGF4elllte$igi~~23!1tE) = $16.20
COMMENCED OR IS ABA~NED FOR .
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ADDRESS:
STATE:
PHONE jl:
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ZIP: 9'7.;'" (/
EXPIRES: /.:>/~
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. CONSTRUCTION CONTRACTORS REGISTRATION jl:
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BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOY 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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DATE I
FOR OFFICE USE
DATE OF APPLICATION:
RECEIPT #: O~J/ 1 i.f
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TOTAL AMOUNT COLLECTED:
ISSUED BY:
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JOB jl: 97/1 (/5
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