HomeMy WebLinkAboutPermit Plumbing 1999-4-5
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BACKFLOV PREVENTION DEVICE PERMIT APPLICATIO:i
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIE::.D OR 97477
0FFICE: 726-3759
INSPECTIO:i LINE: 726..3769
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JOB LOCATION: I ~ L f-t:rI;~I-I>:tn#/
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CONTRA,CTO?j: ~5 //q;''''6>n~.he:-
ADDRESS: Po /JOY 2/?1"
CITY: ~ D'~'h e. STATE: ~
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CONSTRUCTION CONTRACTORS REGISTRATION D: tf /.11 05"
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BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CAi.L~,F,OR"AN IN::?ECTION ONCE TilE
BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS" VIS'tP,JLE.r:~QR INSPECTION
(1'-6-3769). I ALSO STATE TIIAT ALL INFORMATION ON TIIIS'P,E~~T,~~TTON IS
CORRECT. "/..Its ;;;'7~ WORI(
'11. r leu 0" ,. .AN.'DO,~'ZMlr IS Nor ,
r-tI-TIOJ, "cD FOR
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:>J.GNATURI:.
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FOR OFFICE USE
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RECEIPT l': 0 !;d3rCf ISSUED BY:....:....-,7\ . ~
TOTAL ilMCIUNT COLLECTED: -)2/.;),0 ')
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