Loading...
HomeMy WebLinkAboutPermit Plumbing 2000-2-24 . . SPRINGFIELD 707 00 .50 CHANGE: CASHIER: 001 BACKFLOV PREVENTIO~ DEVICE PERMIT APPLICATIO~ CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 -------------------------------------------------------------------------------- JOB LOCATION: I L--b CtJ trJ ~ Pr-t f2-\! I l("W DtL--1 If 'f:.- ' , ASSESSORS MAP #: I 'I ('j '3 Z- 7 '3 I OIlNER: JIl.--l-- f-tb'i ~ (..--A--- . ADDRESS: /1-3.G W fAt ,e..1I1 WJ Dr2--d((... CITY: <;;;('K-ll\I&f\ ~LO TAX LOT #:11LIO ~ STATE: 0 K- PHONE 11: 7"2,.." -}< 67 g-- W: <'Jg'l-'-(70(P' ZIP: "'/7. '--f 7'1 BACKFLOY PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50 CONTRACTOR: Sf6'-'r ADDRESS: PHONE 11: CITY: STATE: ZIP: CONSTRUCTION CONTRACTORS REGISTRATION #: EXPIRES: BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOY PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/ApPLICATION IS CORRECT. ' ""V~~ '2-- ~l/-(} 0 DATE FOR OFFICE USE -------------------------------------------------------------------------------- DATE OF APPLICATION: :;;r/J---,efl (J7) JOB #: (}()()OOOsoJ RECEIPT #: 1m. ISSUED BY: IJ . fYJa(}M du TOTAL AMOUNT COLLECTED: .JJ; / D, so --------------------------------------------------------------------------------