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HomeMy WebLinkAboutPermit Plumbing 1998-1-26 -.' .'_. , , , SPIUNGFIELO " . l \~ BACKFLOV PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION ,{' .:'~, . "'" , ""- , 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 . ::::~::::;::;-::~~~~--~;;;~~~~~~---- OIINER: '%.Gys J-It1.-MES,4'o,; L. L, G. / 1 ,}. , ADDRESSt ..:~<V &,..,.. '~:~i[ u_s, PHONE #~,ttF2-: 5?3'7...\. CITY : .J.$1t4[~!, ~tA'J'E: .. ZIP: 71"' '''U '(.I ~~(, . "6'0 V~O V,z,a (~ . BACKFLOW PERMIT IS $15.00 + $.75 ~~TE9i.~~~ + $.45 (ADMIN. FEE) = $16.20 . . . // ~~ 0'-f<9. ~O'..o ~~ ., ' CONT~CTOR; 11 eV.:5 /J/) /W/5~<{ ~,z,O(). ~-94,A ~~ /0.& . .~' '1S' ~L / ) ADDRESS: ;-- ;;? /.?~(!,(~ ~.-n, ~"f 11: ( 'Y'{)3 b?'-':;> - S1J..::::>) CITY: PC?,714.n/! STATE: ~~ ZIP: P?7..2?' ~ 'CONSTRUCTION CONTMCTORS REGISTMTION 11: qq /0<;- EXPIRES:" ft(J "- ~ .:~ BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). STATE THAT ALL INFORMATION. ON THISPERMIT/AP~LIC T~N r;; n r ~ CORRECT, 7.7 .. ~X t .' . . ,.....- .' . / /' .. ~/<~ .cif t/ -----------------------------------------------------------------------------~(;D DATE OF APPLICATION: I, a 1 \ ct8 . I '. JOB U: Ot 10 (Q]]) RECEIPT 11: A~5 ~L\: ... ISSUED BY: m[ffiJ . TOTAL AMOUNT COLLECTED: ,'~\ .0.0 ....-. . /~6hJ DA';Y , FOR OFFICE USE ~. . --------------------------------------------------------------------------------