HomeMy WebLinkAboutPermit Plumbing 1998-10-2
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SPRINGFIELD II
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nUiles 'IOU t?t" THIS PERMIT SHALL EXPIRE IF THE WORK
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IO\'l,Olegon \h~~,;~go ,%1J81}n AUTHORIZED UNDER THIS PERMIT IS NOT
p;rTE.\'Ii 'dopted b'lBf\j\e'Oll()\7S5t:tll'~TION DEVICE PERMIT APPLICl\TIONENCED OR IS ABANDONED FOR
low lules a tel inOse n Op.fl. 9 ,.fifTY OF SPRINGFIELD , GOMM
10\catiOn cen 0010 tnloUg 01 \M IU'€UttLDING SAFETY DIVISION ANY 180 OA Y PERIOJ).
\'lotI 95Z-001- ain copIes \elepno~ ,
i~~fl.~a~flt~~ote:~~e otilicatlon 'OFFICE: 726-3759
~~~~geB)12~~~~~~~~44). INSPECTION LINE: 726-3769
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.. ASSESSORS MAP If: /7 () -< d).. () 00 TAX LOT 11: bo ~
Ol/NER: ~n./:..-::T ~L JlL,j /:-nekuc.l/i
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ADDRESS: PD, /':5(\)<:' 7K-rS 7
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CITY: .*'I.:::l"nl!:-
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_PHONE #:
726'"-g.b'6/
ZIP:-.1:7nv-r033
STATE:
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BACKFLOII PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20
CONTRACTOR: ~c;.i~~.3 /{:.,<i~~ 4..J~~~~'''' /'
ADDRESS: ~f(~t') ~~/7;::7/,..~ .hi. /';/ PHONE 11: 7"7'?/-7~5 'S
CITY: CdN STATE: rj,1! ZIP: 97//,7<75
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CONSTRUCTION CONTRACTORS REGISTRATION If: /<: ~i:) EXPIRES:;::z.->>W
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOII PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSO STATE TIIAT ALL INFORMATION ON TIllS PERMIT/APPLICATION IS
CORRECT.
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DATE -
FOR OFFICE USE
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DATE .OF APPLICATION: /0 - J- -9(:
RECEIPT II: 03/&3 d-- ISSUED BY: 17.
TOTAL AMOUNT COLLECTEDJ} /1//.. dv
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JOB #: Cf7/ ()!) 0
fYIii' ( La/ /0
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