HomeMy WebLinkAboutPermit Backflow Test 1999-12-15SPRIttG.:IELD
BACKFLOU PRBVENTION DBVICE PERMIT APPLICATICCITY OF SPRTNGPIELD
BUILDING SAPETY DIVISION
225 FIFTH STREET
SPRINGFIE::.D OR 97477 ,FFICE:
INSPBCTIC I LINE:
726-3759
726..3769
JOB L0CATI0N: 1 00 Moharvk Blvd.
ASSESSOBS MAP S:b7 q 1r qo
OVNER:Bros. Real estate
ADDRESS:st. suite #1
CfTY: Eusene, Or STATB: Oregon
TAX LOT {:
PHoNE X3 485-1506
_zr P r97 40l
BAcKFLou PERMTT rs $rs.oo + #(STATE SURCHARGE) + $.45 (ADl :N. FEE) = S16.20
coNrR4gr0Pj :V o.s Pl Inc.
ADDRESS:-
PHoNB *: 48s-0551
CITY: Eu ene, Or 97404 STATE: Oreo6n
BY SIGNING THIS PERHIT/APPLICATION, I AGREB TO CALL FOR AN IN: :)BCTION ONCII TIIEBACKFLOV PREvEN?roN DEvrcE Hes-nnnH rNsrAliED-allo rs vrsrBLE r lR rNSpEcrr()N[[if;3li',' r
^Lso
srArE trini arr, rNFoRHAiion-dn rrrrs pERMit i-ppr.rcArroN rs
CONSTRUCTTON CONTRACTORS REGISTRATION S:41 805
FOR OFFICE USE
Z\pz 97404
iXPIRES:4_OO_
D-A,
I2-15-99.-
DATE OF /.PPLTCATION: \s -sl JO *, Q? lb Y3
RECETPT {,: vl.LTLI<ISSUED DY:
TOTAL AH(IUNT COLLECTED:
&.
a
Ir"<)
SPrlINGFIELt)
BACKFLOV PRBVBNTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAPBTY DIVISION
qv
225 FIPTH STREET
SPRINGFIELD OR 97477
OFFICE:
INSPBCTION LINE:
726-37s9
726-37 69
JOB LOCATION: l20O MoharYk BIvd.
ASSESSORS MAP II: I-I () 32.5 E lo r cv-D
OUNER: Brorrrn Bros Realestate
TAX LOT *:
ADDRESS: 1385 Oak st. suite +1 pHONE *:485-1506
CITY: Euoene,Or STATE: Oregon ZIp:974O1
CONTRACTOR: Vos Plumbing fnc.
ADDRESS: p.O. Bcr x 2l9g PHONE #:495-0551
CITY: Frrrrpno STATE: Oreson ZTP 297 440
CONSTRUCTI0N C0NTRACTORS REGISTRATION *: 41 805 EXPIRES:4-00
BY SIGNING THIS PBRMIT/APPLICATION, I AGREB TO CALL TOR AN INSPECTION ONCE TIIE
BACKFLOV PREVBNTION DEVICE HAS BBBN INSTALLBD AND IS VISIBLE TOR INSPECTION(726_3769). I ALSO STATE TIIAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT.
t2-15-99
DATE
FOR OFFICE USB
DATE OF APPLICATION:
RECEIPT II:ISSUED BY:
TOTAL AMOUNT COLLECTED:* l,,,sD
JoB tt 3q /b F3
r,or
BACKFLoIJ PERMTT rs $15.00 + #B (STATE SURCHARGE) + $.45 (ADMrN. FEE) = g16.20