Loading...
HomeMy WebLinkAboutPermit Plumbing 1994-8-2 ',' (.. . SpntNCFIELO . BACKFLOW PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING, SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759, INSPECTION LINE: 726-3769 Job Location: 10 f..J-1b ~ AJ c1{7)ul~j/L' W Assesso~ 0: lID?; &L.'"3J Ii Tax Lot 0: Owner: "i~ \ -/A.:0\N1_ Address: (115 J).eb Y1 eX- {2.J r I 'UXJ Phone 0: ='3~ :s 5~ 72- Zip: 97l(o J City: k:::--1}'~ " State: {)(L- .' Backflow Permit is $15.00 + $0.75 State Surcharge ~:3~ Contractor: p.~VZJJJ 1 Ji-1A J ~'> CQpe-. M6\+I'\^O,\A)S e,.J (JYL. to 2..8 / Address :7L/ <i{<;f I City: ~/lA~ State: ,j , Construction Contractors Registration 0: Phone 0: 7 t.{ 7 - "37' L{ (~ Zip: Cf7t.(oC; Expires: By signing this permit/application, I agree to call for an inspection once the backflow prevention dev,ic,e has been installed and is visible for inspection (726-3769). I also state that all information on this application/permit is correct. / /1'..2./ ~--L~q \I( Uate ~ Sign~e FOR OFFICE USE Date of Application: g'-7_4../. Receipt 0: \H\.\Pb Issued By: llo.Vl Job 0: Cfc{oZ-22- IA~ Total Amount Collected: