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HomeMy WebLinkAboutPermit Plumbing 1997-7-24 '. . .~~, SPRINGFIELD , " , ,": '~\~~ \s ~O\ "~\c\:,, , ' ,c..IlI ~ ~ ,.,. ,~~ ' "\-\\Sl-l\'Y"':"" -,\: ':," ,~,,\'v0\.."-v , \ ,\\I-\()\'ll.tS) "..;~ \~BACKFLOY PREVENTION DEVICE PERMIT APPLICATION r>.'v~r:::i-.S)" . ,O\), CITY OF SPRINGFIELD cO'</ll~~'2 , ',~ '.I\:.H BUILDING SAFETY DIVISION 225 F~~~' STREET OFFICE: 726-3759 SPRINGFIELD OR 97477 INSPECTION LINE: 726-3769 -------------------------------------------------------------------------------- JOB LOCATION: {qR8'l t=t)rS\./i-h I'~ "ASSESSORS MAP #: 1 'X()2()2).~b~ tiOO TAX LOT #: OIlNER: ' 1 c\w %t 't- 4-<flM }2y,lIJ1ll.. ~ ~ U" ADDRESS: L,q~~J--nV5\/yJA;.~ (j PHONE II: -'7L/J-7J')7 CITY: ~))'\.VrrF;J.Q)/ STATE:, ()V ZIP: ~/7V7? BACKFLOY PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =~ CONTRACTOR: ADDRESS: CITY: PHONE II: ' J STATE: ZIP: CONSTRUCTION CONTRACTORS REGISTRATION II: EXPIRES: BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOY PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/ApPLICATION IS CORRECT. SI~1 <' "'j ~dV/ - ~ a'1 IiAT'B'-I- FOR OFFICE USE ------------------------7----;1~-:-------------------~------------------------ , DATE OF APPLICATION: 7 2Lf..t1-r. " .[OB II: q1 /} 22- RECEIPT #: '()l.(; r 1.1/ ISSUED BY: ;1::, th'~ ' TOTAL AMOUNT COLLECTED: 5b I/f). )0 -------------------------------------------------------------------------------- ~