Loading...
HomeMy WebLinkAboutPermit Plumbing 1999-5-19 . .: SPRINGFIEL.D NO,.'CE:' EXPIREIFiHEWORK , ISPERM\1S\-IALL ~RM\1ISNOl ~~~IlIii~f[ N,",~E PERMIT APPLICATI9N CEDORIS ijF'-'SP~iNGFIELD ~MEN I~ILDING SAFETY DIVISION 225 FIFTH STREWY1800AYPER . , OFnCE: 726-3759 SPRINGFIELD OR 97477 INSPECTION LINE: 726-3769 ---------------------------------------------------------------..---------------- , JOB LOCATION: '"2c, " JIJ1 /J /;.. G/ , ASSESSORS MAP ~: /1 h 1, ') 5' ", ').- Q',INER:""Ii /) JJ nL_ h ,-" C O<.4'n L / /-J c.. , r' ADDRESS: c.).~ 1./ C'4:>LJ-t.vur",'p TAX LOT~: 0"')7.. 00 * CITY: C. p'-\ ~_ "'""":'. STATE: OlL PHONE~: ''-/7_ t;DJ/7 ZIP: 9/~17 BACKFLOW PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20 ADDRESS: CITY: r/7 A'- d CONSTRUCTI~ ~6NTRACTORS REGISTRATION. ~: .PHONE~: LlrFI-.9}Jt9 STATE:t'V ZIP: 9'.lfO...> 2...J>7 ~1ZfENTION:orEg<l11IRBs:~ryfJ.~.- follow rules adopled by Ihe r Y I "ly , Tin Cenler. Those ruleS are set forth BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO C~ II ODe!l1~miOO90N()l;l-1 'lIHE-001- BACKFLOW PREVENTION DEVICE HAS BEEN INSTALLED AN~ . girk"OOl!l!:'NON~ rules by (726-3769). I ALSO STATE THAT ALL INFORMATION ON' ca In' \M'.~~;I{~Qliem~hone CORRECT. numberforthe Oregon Utility Notification Cenleris 1-800-332-2344). ~ t>Lw. ~L~ Wl~ V_rl )il,/lV d{LftTI CONTRACTOR: ~ ?://Z/_ '7''''' jP#! -' bAT(f~9 FOR OFFICE USE -------------------------------------------------------------------------------- DATE OF APPLICATION:';/ I rl r' /7 /1' Il JOB lI: qqo C:, 80 RECEIPT #: O)l{o7 Co ISSUED BY: & v1t<-/' TOTAL AMOUNT COLLECTED:. /0.'--'()