HomeMy WebLinkAboutPermit Plumbing 1996-2-26
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SPRINGFIELD
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BACKFLOY PREVENTIO~ DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225'FIFTH STREET. OFFICE: 726-3759
SPRINGFIELD OR 97477 INSPECTION LINE: 726-3769
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JOB LOCATION: (;~~~\\" c:;.,~n'4Le.lJ i tw
. ASSESSORS MAP 1I: /?-b'1-?2-...c>t:::' TAX LOT 1I: ~ 2 2L:>?::>
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ADDRESS: 3 'LOt 9-.t" Q.MP~ ('...T)UX-~ PHONE It:
CITY:-C ..f)'N.Jvrr.. STATE: ne ZIP:~
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BACKFLOY PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) ~ $16.20
CONTRACTOR: \\-(")i'C"I_~nY\ ~'5Cap.o, CO.
ADDRESS: vJj, (JY)'i \ \Sh 7 _ PHONE It:M/o-(~L/ tJJ9
CITY:LlJ.c..JJf\O \ De... STATE: Oe- ZIP: 91d4o
CONSTRUCTION CONTRACTORS REGISTRATION 1I: Lo~~' EXPIRES:
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BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOY PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT.
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DATE
FOR OFFICE USE
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DATE OF APPLICATION: --2-2C-c::::JC.
RECEIPT 1I: 2c::JY~ ISSUED BY:
TOTAL AMOUNT COLLECTED: /.6.7C>
JOB 1I: Q5"'/ih97"'.
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