Loading...
HomeMy WebLinkAboutPermit Plumbing 1998-8-10 . . ,;~ .... . go~ res ,Oil Ie follow r ~e Oregon Utility NOTICE: Notification Center Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WORK In OAR 952-001-0010 through OAR 952-001- BA.C15E~R1fr f~~~TION DEVICE PERMlltl9U?l'tbWt\i'll,QlV)taln copies of the rules by AUTHORIZED UNDER THIS ,veITY OF SPRINGFIELD calling the center (Note the telephone COMMENCED OR IS ABANDONED FOIIUILDING SAFETY DIVISI~mber for the Oregon Utility Notification lOf) Center IS 1-800-332-2344). 2\tf(I1!ltflf'Ys%.~IS'l.~ OFFICE: 726-3759 SPRINGFIELD OR 97477 INSPECTION LINE: 726-3769 -------------------------------------------------------------------------------- JOB LOCATION: /7/0 (EI//Tt.3;1/t1))/!---L. /7 ()3:J5' 3 q; OIlNER: 11-11/1 V 5 j)/ 22 A- / ADDRESS: /7/0 !:ENTE/I//V//f-L CITY: 5;ttZnv 6'- t,,-,--7 I? , ~ ~ - ASSESSORS MAP #: TAX LOT #. OlC;(Jb STATE. PHONE #: 7'17 - 4'fLfS' O~ ZIP. 19c;J7 BACKFLOII PERMIT IS $15.00 + $,75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) ~ $16.20 CONTRACTOR: 1'U/IA/ ADDRESS: I ? J ., Kr V/=' /!- <) ;-/2 t//N C- fJ/1A m j/Nq / CITY: ?-_I A ~ ~1V t STATE: PHONE #. D^- /7C,,'l) 0fJr,- J'-t'lL/ ZIP: 99'/6'-/ EXPIRES: tiff CONSTkUC1iON CO~TRACTORS REGISTRATION #: BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCr THE BACKFLOII PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769), I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT. ~c,~ SiGNATURE fI/(0/r7 DATE ( FOR OFFICE USE -------------------------------------------------------------------------------- DATE OF APPLICATION: RECEIPT #: 'b/fb /q 2 TOTAL AMOUNT COLLECTED: ISSUED BY: lc- 2-e) JOB #: fg 0 9'1 & ~ tJJ -------------------------------------------------------------------------~------