HomeMy WebLinkAboutPermit Plumbing 1997-6-16
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SPRINGFIELD
BACKFLOV PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225, FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
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BACKFLOV PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20
CONTRACTOR:~)(\d / '
ADDRESS:
PHONE II: .
CITY:
STATE:
ZIP:
CONSTRUCTION CONTRACTORS REGISTRATION II:
EXPIRES:
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). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT, ' '
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'.,' 61;6/97
DATE 1'1, ,
FOR OFFICE USE
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DATE OF APPLICAT~~lo .\ h .Q1
RECEIPT 1I:61\n\~ ISSUED BY:
TOTAL AMOUNT'COLLECTED: \\().7{)
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