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Home My WebLink AboutPermit Plumbing 1999-9-2 . . \/0\\10 n\llleS, SPRINGFIELD .~,IA .....,\\W _" ,'/. i':,~1 "',~ .11~ .it t ~il~w {ules a: n~~;~\\10se IU~O~f\ g! .. ,- NO\iIiC~~;?o~~-OO~ 0 ~\1~~~~s 0\ \~:~\10ne in 0"'0 'IoU lOa.'! O~~\ ~Note: \~e ~oti\iCa.\iOn n09 . '\1" roen . _~ \ \\11\\':1 .. BACKFLOV PREV~~~ON DEVJCEePERMIT~AFP~iCATION g'fllieOF11 S'pRiNGFrELD'~ ~. BUILDINGCS'ili1ETY DIVISION ~~::~~~~~~~~----------------"------,---------~~~:~~~:~~--~~!:!~!!~ JOB LOCATION: M- '33 !L-/fL-H 1(1- . . ASSESSORS MAP #: 1~()205)'I TAX LOT #: CJ~/oO OIINER: M\'2- J ftij2.~, 1Z.ob//l2SoN, ADDRESS: #3,?1LA-lH;'/t CITY: 0PV2-INCI) rl fl-L.t) PHONE #: 744-- ~ 783. ZIP: 9747?J STATE: OR- BACKFLOV PERMIT IS $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) =$16.50 . CONTRACTOR: rZ..A-fAJ'?CA-ff'-5 SfQ2-/'\)ILLrac.. ~ UJ-f0DS<:.P, lDNJlMdofIX ADDRESS: .?-4-7D c0A-IL yrwO(' PVL PHONi #:\ 'i'f]) 4-<0)".. 4-S'00 CITY: ~ 0\9 E. STATE: &XL ZIP: Cf74-0:3 CONSTRUCTION CONTRACTORS REGISTRATION #: (03ro5 EXPIRES: fM#c.~ . tfOl"I\.it;; HALLEXPIREIFTHEWORK - BY SIGNING THIS PERMIT/APPLICATION, I AO~2P~~~~H~~~.g~~tO~CONCE THE BACKFLOV PREVENTION DEVICE HAS BEEN INS~~~~ ~B~ECTION (726-3769). I ALSO STATE THAT ALL INFO~~gacmnw~. ~P~LI-CATION IS CORRECT. . ANY~80DAYPERIOD,' ,- ~ilfu~ 1- /~;~ 2-~ 1i DATE FOR OFFICE USE ::::-::-:::::::::::~---~j7~-Jt~~------------------------:::-:~-~~;;q-7----- RECEIPT #: O$r;c.; ~ '1 ISSUED BY: d?Jw TOTAL AMOUNT COLLECTED: 1b.5V --------------------------------------------------------------------------------