Loading...
HomeMy WebLinkAboutPermit Plumbing 1994-7-21 . . BACKFLOW PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING. SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: INSPECTION LINE: 726-3759 .M 726-3769 T .. Job Location: 2. 340 L0c...L D;', Assessors Map U: Tax Lot U: o~ner: 'i.' -9\<L~'\ ~ t~U.uO'll ~ Address: 2- 3 If.D' L.Dc..t.. /Jr, Phone g: City: 5,C)~'\f" id State: (I,.t, Zip: 7'747-0'" " " Backflow Permit ;s $15.00 + $0.75 State Surcharge ~~ 'contractor: 's-/...(s-K.. ) ,;t.1 c k:_ ~ ,'. LG.",-dr-r 'Y' G~J r"'~;r<-j,b~ /./,,,,,c, Phone U: 7 t/-(j.- 7 I )'5 1 - ()~ Address: <fll (, ~,., ~IJF!cl. . State: v Construction Contractors Registration H: /2/ 7D Zip: '} 71/-7'7 Expires: '2'/;/ )94- I I " City: By signing this permitlappl ication, I agree to call for an inspection once the backflow prevention device has been installed and is visible for inspection (726-3769). 1 also state that all information on this application/permit is correct. ~.^~ Jrj 14 Signature - ~ "/ /'2. i /94 Uate l . FOR OFFICE USE Date of APPlication:~.cOLl.~ ~. Job U: Receipt U: \4.\'01 Issued B:/.:_7)\ff'\ ) Total Amount Collected: \\0:70 ' Cl4\\\ \