Loading...
HomeMy WebLinkAboutPermit Plumbing 1998-1-27 . e: ,.f Ii DACKFLOV PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD DUILDING SAFETY DIVISION .(' 6:'~" . ",. , .... , 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 ~::-:::~~:::~-----~~~~-~1(~~---~~~~l-~-~--~~---------- .' ASSESSORS MAP II: W''\@\)Y\~- - ~~~ ~~T II:~)O ,.," O~NER: '%.6"YS Ht:J,M,,?;"> L. L, C. / ADDRESS: ?:"o. &~ S?/~ <e..u_So PHONE {5~~ 6ff2> 5~7~. CITY: /).p /p b--' STATJt.: ,. ZIP: ~V~C " BACKFLO~ PERMIT IS $15.00 + $.75 (STATE~~I~~ + S.45 (ADMIN. FEE) ~ $16.20 '. . // ~ / I ~ C'04?'4t JyO~<.< ~l' <5'~ . . ' CONT~. CTOR: 1'1 /~V.5 r/ /) .!'tilf';s, ~-1-", ~O/Il ~t/ ' /0& . v(j{'O ''V, . ~~. (~ ) ADDRESS: :--- .:J OC;-c? .~ 0",;-... 009,_ ~-9,p U: ~OJ b 1-/' S7J~} .~u ~\~ ~ CITY: PC?/7 /4-1'1// STATE?70~~,o~.t) ~,(-. ZIP: ~7.,;2..?- ~ . ~~ "'?'I)- ~ /.. CONSTRUCTION CONTRACTORS REGISTRATION II: 1~ / OS q,~0/.) {s>iP~ES: 9',/~e , 0-9 O/' . DY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE DACKFLO~ PREVENTION DEVICE HAS DEEN INSTALLED AND IS VISIDLE FOR INSPECTION (726-3769). STATE THAT ALL INFORMATION ON THIS PERMIT/AP~.LIC T~ON jI,S n r ~ CORRECT., ~X t " ..' //. ' '".fL/< ~ l/7> y .........-. OATrY~J FOR OFFICE USE -------------------------------------------------------------------------------- DATE OF APPLICATION: _ \ ,:{ Y'\., C\ 9: RECEIPT II: !4 '7<..5"6-'5 - , - ISSUED DY: (~\.~I) vl '. JOD II: (\QT\U:a.h U,\ffi) , ~ ) TOTAL AMOUNT COLLECTED: .. --------------------------------------------------------------------------------