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HomeMy WebLinkAboutPermit Plumbing 1998-10-2 . . SPRINGFIELD II ~ nUiles 'IOU t?t" THIS PERMIT SHALL EXPIRE IF THE WORK laW Ie... nll\ill" 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 ;;,~::~\"~/;'~/---~;'~-:4.~~-;ji(;iZZZ;2;-~~/ .. ASSESSORS MAP If: /7 () -< d).. () 00 TAX LOT 11: bo ~ Ol/NER: ~n./:..-::T ~L JlL,j /:-nekuc.l/i - . ~; ADDRESS: PD, /':5(\)<:' 7K-rS 7 d CITY: .*'I.:::l"nl!:- / _PHONE #: 726'"-g.b'6/ ZIP:-.1:7nv-r033 STATE: ~R 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 ~ . - 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. ,~LIf .. If; -.2-~ DATE - FOR OFFICE USE -------------------------------------------------------------------------------- DATE .OF APPLICATION: /0 - J- -9(: RECEIPT II: 03/&3 d-- ISSUED BY: 17. TOTAL AMOUNT COLLECTEDJ} /1//.. dv . , JOB #: Cf7/ ()!) 0 fYIii' ( La/ /0 --------------------------------------------------------------------------------