HomeMy WebLinkAboutPermit Plumbing 1999-1-22
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NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER!W~J{,T'~~II'PRE~1>lfrION DEVICE PERMIT APPLICATION
. ." 'CITY OF SPRINGFIELD
COMMENCED OR IS ABANDONEQ FC'IfUILDING SAFETY DIVISION
M'V 1W! J)AY PERIOD.
225 FIFTH STREET OFFICE: 726-3759
SPRINGFIE::,D OR 97477 INSPECTION I:INE: 726..3769
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JOB LOCATION: 2" 1/ L o...v-'('"o- S'j-'r.Qe+-
ASSESSORS MAP ti: t70 3'2.."" I D
OIINER:
A4 0 0 s....
L" ..I'J .R-
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TAX LOT ti: ~2-l()'D,
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"PHONE ti:
ADDRESS:
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CITY: )0""'7 -J.. ",,-tel STATE: ()K ZIP: 97.,..-77
'BACKFLOV PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) a $16.20
CONTRAp'l'Ol'j: OvJ\I'-ZV (~.5e hc:~ ero ;<o-wly (JYccl<- ')
ADDRESS: /_0:.// Lc.............-c... f{y~ PHONE ti: 7~?~tJn7
CITY: ()/7y; "^'" F.' ~t"/ STATE: (Jf2 ZIP:'7?V?? .
CONSTRUCTIOt CON~CTORS REGISTRATION ti: EXPIRES:
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV PREVENTION DEVICE HAS BEEN INST~~~i~;J;II~E FOR INSPECTION
(726-3769). I ALSO STATE THAT ALL INFOR~btP~IB~a~H ~~Ulf9.N~~Lte~trON IS
CORRECT . . . "y ine Oregon Utility
. Notification Center. Those rules are set forth
, in OAR 952-001-0010 through OAR 952-001-
zg tV 22 0~090 You may obtain copies of the rules by ,
, ling the center. (Note: the tel phon ~
-:~- "-L t? . ~ '-'1' .', "berforthe Oregon Utility N~trcat~ /---? 7
i:r1 "NATURI:. ~ . "ente, is 1-800"33DA'l'~).
FOR OFFICE USE
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DATE OF /;PPLICATION:
RECEIPT I': () "$1..." 'f 'Z..
TOTAL AMOUNT COLLECTED:
~/"{H
ISSUED BY:
JOB ii: q 'i oo1~
4' tJJ
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