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HomeMy WebLinkAboutPermit Plumbing 1998-7-28 . . uO!leO!l!ION h\!I!ln U069JO 941 JOj J9qwnu AUTHORIZED UNDER THIS cIlt 9U04d9191 941 :910N) 'Ja1U90 a416u!IIeO ' ^q s91nJ a41jO se!doo u!elqo ^ew nOA '0600 COMMENCED OR IS ABANDONED FOR - WO,~g6l:l\fO 46nOJ41 0 ~OO- WO-~g6l:l\fO U! ANY' 80 l)b v /3t:RIOO. 4lJOjleS are S91nJ eso4~A.llIW~\Udijij:lWlijjijION DEVICE PERMIT APPLICATION ^llllln uo6eJO e41 ^q peldope SelnJ M_O~TY OF SPRINGFIELD oi no^ s9J!nbaJ Mel u06eJO:NOI.LN~mDING SAFETY DIVISION 225 FIFTH STREET OFFICE: 726-3759 SPRINGFIELD OR 97477 INSPECTION LINE: 726-3769 -------------------------------------------------------------------------------- ..' JOB LOCATION: 6'7 RG ~,/ h--. / 1>.-L ,V'1-f) I ~ rJ 'h.telf-, I J ' . ASSESSORS MAP ll: It O:L 04 /; 4- TAX LOT ll: 03907') OIINER: ~"m.,vo != ~ p,--t-t+,) L. AlA "f, I' I I ADDRESS: ,?,'.-,pq l:::;7j~;", L"" .V'.t; _PHONE ll: CITY: 'r r-I ""'\ C.-.\.JJ. ',< STATE: (l.f? 7w-z,~ ~ ~ ZIP: q' 7li 17 BACKFLOW PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (APMIN. FEE) = $16.20 CONTRACTOR: MA'oI '" t( ,'he-. ADDRESS: ~ o. (0/0 CITY: rna'Y~f1 10....-. CONSTRUCTION CONTRACTORS REGISTRATION ll: La /V'>)-C' e:c.p P ~f"t.J ) to - k-Lh PHONE ll: STATE: (',)-V. (,,74~ 933 -:;2. 7<-1'-..- ZIP: q7Yl~ EXPIRES: q /3J I q r BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOW PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT. Sl~> ~ ~x;-li; 7~ .;;;. .P. q. 51 DATE . _____________________________r~-!-O!--O!!-I-C-~-U-~E--_____________~____~____________ DATE OF APPLICATION(! IrK k ^ JOB II :gX(Y1~ RECEIPT ll: 02..;"{JJ(p , ISSUED BY: /J .lYk'lf../rdj)i , TOTAL AMOUNT COLLECTED:Jh//; .2D . . . . . , \ ~ -----------------------------------------------------------1-------------------- ,(