HomeMy WebLinkAboutPermit Plumbing 1999-7-30
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SPRII : GFIELD
BACKFLOI/ PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
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JOB LOCATION: 203 !f1'7 Q~{){/e{)/-)t.e- ';Pr<-
. ASSESSORS MAP I: / 7rp .J (/7:2) ,
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ADDRESS~13 '77 C;;ri'Ot/~ /I-( e
CITY: 9/:Jji2f;V$;:}gLD
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STATE:
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BACKFLOI/ PERMIT IS $15.00 + \.05 (~tA~~ siiil.ciJAil.GIl~ -I- $:45 (ADMIN: PEE)
CONTRACTOR: OLU~
ADDRESS: ,piibN~ fl:
CITY:
STATE:
ZIP:
EXPIRES:
CONSTRUCTION CONTRACTORS REGISTRATION I:
BY SIGNING TillS PERMIT/APPLICATION, I AGREE TO CALi. FOR AN JI1SPECTION ONCE TilE
BACKFLOI/ PREVENTION DEVICE liAS BEEN INS~ALLED AND is VISIBLI: FOR INSPECTION
(726-3769). I ALSO STATE TJlAT ALL INFORMATION ON TliIS PERMJT//iPPLICATION IS
CORRECT.
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LATE '
FOR OFFICE USE
DATE OF APPLICATION: '1- d-- '\ - '1 "l
RECEIPT It: .%6 L!<<:' ISSUED BY:
TOTAL AMOUNT COLLECTED: df; f fa. s;o
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