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HomeMy WebLinkAboutPermit Plumbing 1993-11-5 . . 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 ~ L~ <;,c..~L ~. 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 . Si9~ "' (,~ ~ l/ . d' 7"3 Uate 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