HomeMy WebLinkAboutPermit Plumbing 1999-5-11
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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
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JOB LOCATION:::b!>.......-..n""'" ?",.rn:-'="""....~ ~...
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ASSESSORS MAP #: \., (\..... _~ :>.\
TAX LOT #: O~"3"t:\tI
OYNER: \~\I\ L....... -:\_ ~'('L '''~
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ADDRESS: 'i'O'~t:: (.;eN>G-"-Tn'.../v ~..._
PHONE #: 93.~-L'l '3'-1
CITY: '-\UI\tt"_T"tOt.L ("'TO"
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STATE: OR
ZIP: -5...7"'-1 't R
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BACKFLOY PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIK. FEE) = .$16.20
CONTRACTOR: \\.".. k?~ ?c.uW\"'""_
CITY: EUl".E...o
STATE: O~
PHONE #: ("~k-\.Lf'i'-l
ZIP: 9'.lj(\~
EXPIRES: ~ /11 /01
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ADDRESS: \ ~:z.s:- \ Chn..r_ "t--.....
CONSTRUCTION CONTRACTORS REGISTRATION- #: \'1"'i~
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPSCTION ONCE THE
BACKFLO\l PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOP. INSPECTION
(726-3769). I ALSO STATE THAT ALL INFORMATION ONAf~E~1~~r'68;r~tf~~?fes~~uto
CORRECT. follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 95:1-001-
0090. YDU may obtain copies of the rules by
calling the cent~ ff:JWl; the telephone
;-,u, "berforth~~IIIlY I~Dli"catlOn
Center is 1-800-332-2344).
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FOR OFFICE USE
DATE OF APPLICATION:.c; -11-- 90
RECEIPT #: '339~' ISSUED BY:(\
TOTAL AMOUNT COLLECTED:, <t /1 /J. au
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JOB it: Otqo JlO
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