HomeMy WebLinkAboutPermit Plumbing 1994-6-30
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SPRINGFIELD
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BACKFLOW PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING~SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location:
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Assessors Map If: \f)O~ 714 Tax Lot #:~\OO
Owner: Oav;J L. C '<
Address: II 30 C...u h., W""
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City:
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Backflow Permit is $15.00 + $0.75 State Surcharge~'~
Contractor: (
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Address:
Phone II:
City:
State:
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Expires :.
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Construction Contractors Registration #:
By signing this permit/application, I agree to call for an inspection once the
backflow prevention device has been installed and is visible for inspection
(726-3769). I also state that all. information on this application/permit is
correct.
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6-10-i'l
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FOR OFFICE USE
Date of Application:
Receipt #: \~~
Total Amount Collected:
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Issued By:
lLe . 9-0
Job #: Q4CR11
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