HomeMy WebLinkAboutPermit Plumbing 1993-6-21
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BACKFLOW PREVENTION DEVICE rERMIT APPLICATION
CITY DF SPRINGFIELD .
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Dregon 97477
Dffice: 726-3759
INSPECTIDN LINE: 726-3769
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Job Location:
2/5"'c/ /~p~ 0/7. 4'~CE 22 7"
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Assessors I~ap U: /)~t::>5 :2)-/~ .
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Tax Lot U: ~ ~y~
O\~ner :
Address:
Phone U:
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Zip: f}..-/'7?-:::>
City:
State:
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Backflow rermit is $15.DO + $0.75 State Surcharge
Contractor: cf7/#/YCA'" /7 E#.#~:;r-
Address: Phone U:
City:
State:
Zip:
Construction Contractors Registration U:
Expires:
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 application/permit is
correct.
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FOR OFFICE USE
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Job U: ~'~ _ :>:c
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Date of Application: ,6 -2,/~ '3
Receipt II: q//7 Issued By:
Total Amount Collected: /5:7>
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