Loading...
HomeMy WebLinkAboutPermit Plumbing 1998-1-26 ..' , e.-. ~f \~ BACKFLO~ PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION ,- ,'{J. 6:~, "", I''''. , 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 .. ;::::::::;::;-:---~~~~Cil-~~~;-~:::;;':;----- O~NER: '%.6"ys Ht:J,M,,?;"> L. L, C. / ADDRESS: --7:'0. &~ S:;::.,;'....-z<e~_":. PHONE U(5rj~6ff2>5~U', p.p/pv--' S'l'A~: '. ZIP: J"; O~ BACKFLOIl PERMIT IS $15.00 + $. 75 (STAT~S~)j:~4 + $'.45 (ADMIN. FEE) = $16.20 OJ"; ~'."'P.' J/ C'~~ 'YO-sJ ~r CONT~CTOR; 1'1 .e-V.5 /-!/) ~~'4,&" ~<,<'n. O'~, r:()& . , '6l .(.(:; v~ ~< ( ) ADDRESS: v:;2/?c;-U"> !70od. ~O^ e><,<'.o ~''''E jl: ~03 b1-./' m~J '.0 '{S> "~~<,<' . CITY: //0/'7 /eu.u// STAT~17.C'~..r.=.o~,('~l ZIP: P?7..2?-;- CONSTRUCTION CONTRACTORS REGISTRATION II: 1~ / O"~4',(-~~r/n ~}RES: 9" 1'6 v/;; "JIb.. ,.,.. /7 0-9 'vr BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLO~ PREVENTION DEVICE liAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769) . STATE THAT ALL INFORMATION. ON THIS PERMIT! APP.L LI!~CCr Tl)ON jtj5 n r ~ CORRECT. 7 0) , ~ <t1. ,?X t ./"'-- " , ~~/~ .v? (/ ,', .";' . CITY: '-. "Fha FOR OFFICE USE ::~:-::-:~~~:::~:::~-----i~~f\~~~--------~----~-------:::-:~lJ\~()I(:)'l- RECEIPT II: ~~5<6G.\.' ISSUED BY: (\\f\ll.; TOTAL AMOUNT COLLECTED: c~\.{jf) ~. ~. --------------------------------------------------------------------------------