HomeMy WebLinkAboutPermit Plumbing 1993-11-5
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BACKFLOW PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location:--5~9 ~(fm; H, PG:+LI( .
Assessors r~ap n: \f\D3~\~
Owner: Yun ~S
Addres s: 53'1 b':A-n: H_ P lA-<-T
Tax Lot n: ~f([)
City:3lpr1'",Q. L't2d
, IU
State: 6YlL
Phone II: 7:J-~ /-1 fJJ 6
Zip: tj 7Y"J!
Backflow Permit is $15.00 + $0.75 State Surcharge
Contractor: ~CVY\b~
Address: ~.n. ~1\1 t'I\5"';:L
City: 4,~
, 11
Construction Contractors Registration" n:-tL.5_~l ~
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Phone II: (p~Ia-1:,l("'~
State: ~L zip:...:J.Ltflf D
Expires: JJ2l3iJ(I.!Y
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 that all information on this application/permit is
correct .
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FOR OFFICE USE
Date of Application: \ \-5..q~ Job n: G\'6\1ol\~
Receipt II: \\\.Q:.(fJ Issued By: (~l ~ )
Total Amount C:llect~d: \ ~ .f":l.5