HomeMy WebLinkAboutPermit Backflow Test 2001-04-09CITY OF SPF INGFIELD, OREGON
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BACKFLOI,I PREVEMION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAPBTY DIVISION
225 FITTH STREET
SPRINGFIELD OR 97477
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OIINER:
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726-3759
726-3769
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PHONE *: (7O7 "38O-7>5c
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BACKFLOI PERMIT IS $15.00 + 1.05 (STATE SURCIIARGE) + $.45 (ADI{IN. FEE) =$16.50
COMRACTOR:
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BY SIGNING THIS PERUIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOU PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION(726-3769). T ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT.
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