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Home My WebLink AboutPermit Plumbing 1998-9-14 " -------------------------------------------------------------------------------- . JOB LOCATION: & 73 7 G! dC-{-<../ S:o/,,n i~~/L ()1'~Je::v? , ASSESSORS HAP #: /'60)...... O?, 1/ TAX LOT #: ()~ OIINER: ,~R /?r; U- ~, '6.6 I.? . 8u; U-Lr 1 ADDRESS: p. 0. 8'l>;(771':1 PHONE #: 3f/2- 0'? ? CITY: IE U-q~ ,f5/' 97t.i)) STATE: O/~~/.) /) ZIP: 97<(tJ> " . I : BACKFLOW PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20 CONTRACTOR: 5TAA c..JtA)D5c.APe 5c oT(. Sc HI1/! ~e ADDRESS: Q3o/"c, 'K,eJER. ~e>~ PHONE#: 'J?~-Z-051 CITy: g'kfLUw'11.. CL~ STATE: /)j(~D~ ZIP: 'l1L(c{~ CONSTRUCTION CONTRACTORS REGISTRATION #: ~ { f t,- EXPIRES: /2 -3r-?f' 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 TIIAT ALL INFORMATION ON TillS PERMIT/APPLICATION IS CORRECT. P6t4,oId_ 1._ -SIGNATURE - 7' ~ II - f'JY DATE FOR OFFICE USE ----------------------------------------------------------------------..--------- DATE OF APPLICATION: q-I'f- &J r( JOB #: q7/&/9 RECEIPT U, 914 ,!.p ISSUED BY: ".<MJ TOTAL AMOUNT COLLECTED: J / &-. d-O --------------------------------------------------------------------------------