HomeMy WebLinkAboutPermit Plumbing 1995-4-5
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SPRINGFIELD
BACKFLOY 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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TAX LOT jI:
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JOB LOCATION: Gl.-Ov~O""'-"~-:or
. ASSESSORS MAP jI: 1~f:l~~<4-
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mINER: ~~ C-lA-"-l &
ADDRESS: .~40b ~A-U)y'
,CITY: r--,-"9il.ArV1r\Z11U-D
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STATE: nTL
ZIP: 17"+7'1
CONTRACTOR:
THOMPSON LANDSCAPE
GCMPli. /,,'
P.O. BOX 11562
eUGENE, YFlE\ilYN\I.:r~1jI
CITY: STATE:
CONSTRUCTION CONTRACTORS REGISTRATION jI: (ru~c;. \
(ADMIN. FEE) = $16.20
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BACKFLOY PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45
ADDRESS:
PHONE jI: /oC{.(o - ?> ~1
ZIP:
EXPIRES: .Le..)30 )<11<;)
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 I
FOR OFFICE USE
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DATE OF APPLICATION: 4.\D.q:; l J:.. ^ '\ JOB jI: q{1~
RECEIPT jI: \\cQ.Q3 ISSUED BY: ~f\.V ..-
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