HomeMy WebLinkAboutPermit Plumbing 1994-8-23
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BACKFLOW PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 F1fth Street
Sprlngf1eld. Oregon 97477
Off1ce: 726-3759
INSPECTION LINE: 726-3769
Assessors Map II
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Tax Lot II. n~~
Job Locat1on
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Backflow Pen11l t 1 s $15.00 + $0.75 State Surcharge T ~ O"?o
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Contractor'
Address
Construct1on Contractors Reg1strat1on D'
Exp1res'
By slgn1ng th1S perm1t/appl1cat1on. I agree to call for an 1nspect1on once the
backflow prevent10n dev1ce has been 1nstalled and 1S v1s1ble for 1nspect1on
(726-3769). I also state that all 1nformat1on on th1S appl1catlon/perm1t 1S
correct.
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Date
FOR OFFICE USE
Date of Appl1cat1on' R A~ ,Cf4
Rece1pt II 1M ~~ Issued
Total Amount C~llected~ \~
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