HomeMy WebLinkAboutPermit Plumbing 1999-7-19
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BACKFLOY PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET OFFICE: 726-3759
SPRING;q:JE,lilMfbW<1?? ,_.. INSPECTION LINE: 726-3769
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JOB ~~if,f0: Q~_~~~~~~~o~U~ NOTICE:. _,_, __
ooa ~2.vvl-uulJl:j~.*.ft,," ~IHI::;I-'t:HIVlII ::>MI\UO.':N'h....I, -:lIEWORK
. ASSESS~Q"Sy~fl1EW:~*ai~lIcl1?i2 _ 9~1 07& crv ~~[jIt.;['.[lFRTHIS PERMIT IS NOT
~nn9lheceme J~..:.t!:!e'I' ~'''''',"DY .
OYNERlumlle~r~fn@~Ne'~~lJone COMMENCED OR IS ABANDONED FOR
,-,emer i~ J -8Q(l,.;:3:12\;;~:'~J~ ANY 180 DAY I-'I;l:j!Yu.
ADDRESS: ;;1. \ -nkt{po-r.-~ w~ PHONE 1I: 1'11-1dri-1o
CITY,_ -:5P~ '.....,. STATE: Dr<.. ZIP:
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BACKFLOY PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20
CONTRACTOR, TWJ 1V\M::f( tJ
ADDRESS: ~d-\"'<6 8L.O'Z>~ 'S:T
CITY: ~
CONSTRUCTION CONTRACTORS REGISTRATION. 1I:
PHONE 1I: _1.4 h)~H-'
STATE: ~ ZIP:~
1I3sr E:-:PIRES:~
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOY PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOI( INSPECTION
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
roRRE~ 1/Mc
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FOR OFFICE USE
DATE OF APPLICATION: 7- J0- gq JOB it: C1,O;OQ7L(
RECEIPT 1I: O.5'-f 96/ ISSUED BY:(\ . (Y)a.d"l:1 pLo
TOTAL AMOUNT COLLECT4I/ ~ .00