HomeMy WebLinkAboutPermit Plumbing 1999-1-25
r/
.
.
N - gOI1I" i~y~
ATTENTIO :Ure ~ Oregon Utility
follow rules adoPte1h:~rules are set forth
BACKFLOV PREVENTION ~~~'Plfgc#trf:>;!,6i\!!1I~AR 952-001-
CITY OF:~* t;>,tain copies of the rules by
BUILDING S~m,y lfl.!h ~ter (Note: the telephone
calling t e c . Utility Notification
225 FIFTH STREET number for the, Oregon '_23lf~+CE: 726-3759
SPRINGFIE:"D OR 97477 CenteflS 1rNS~E'WIC'1 LINE: 726..3769
',/
--------- ------------------------------------- --- ------------ - ... ----------- .- -----
"
,
JOB LOCATION: 5/~<1 tYdk#t:T?
" ASSESSORS MAP ft: /1rx 222m /
OVNER: Eyht7;1 ,.4//t:'H
ADDRESS: ,., /S-eJ 6t/Tt'U/7
l' ;P/'/h;l~/~/d
~
,
,TAX LOT 1': ~ {j () ()
~.r:' ,PHONE ft: 7'?~ -6 t?//,
STATE~~Q;)CE: -__zIp.:fZ~77
- THIS PERMII :;r1I\LL 1:^"ln... ,,' I HE .._,...
.. 'TO "'qI7E~ I '~]DJ=R THIS PERMIT IS NOT
BACKFLOV PERMIT IS $15.00 + $.75 (STATE SURCIIARGE-) +. $.45 (ADI IN. FEE)FDR$l6.20
C21,;i.'U:C::C Oq IS ABANDO~.tu U
C;ONTRA,CTOl'j: 11/ /.If7'/' Fka/ 5;-t!!-C//d/Wr'S.v PER]OD
"
ADDRESS: 9'/ Z J/ 5"1- PIIONE ft:.? %-b Y2--?
CITY:---i'J'7r<f4uth-'e/d STATE: C'r ZIpj?:7f77 ,
, / 'i
CONSTRUCTION CONTRACTORS REGISTRATION ft: /2- 6' t77J' r.XpIRES: /r-S--~
CITY:
BY SIGNING TillS PERMIT/APPLICATION, I AGREE TO CALL FOR AN IN::?ECTION ONCE TilE
BACKFLOV PREVENTION DEVICE liAS BEEN INSTALLED AND IS VISIBLE 'OR INSPECTION
(726-3769), I ALSO STATE TIIAT ALL INFORMATION ON TillS PERMIT, ,iPPLICATION IS
CORRECT,
/fKfl.-VJt//~
:ilGlifA'l'ifiu:. /".
1-:-25" /J?
DA'.';;
FOR OFFICE USE
---------'-----------------------------------------------------------------------
DATE OF /;PPLICATION: { / ~J /f /
. I
RECEIPT I': IJ '5 2...' ~ 4 ISSUED BY:
, j} JO:, #: qq 0/03
J() ,
TOTAL AMOUNT COLLECTED:
('.2-
--------..---------------------------------------------------_.. ----------_.~ ------