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Home My WebLink AboutPermit Backflow Test 1998-12-01APFII{C .IELE, BACKFLOW PRBVENTION DBVICE PERMIT APPLICATIC : CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 FIFTH STREETspRrNcFrE::,0-on-izazz rNspEcrrc itllftE: ltrt tlZZ JoB LoCATI0N: /Z ru /Za r/a,*2 AssEssoRs t{AP $, i 71 7 zs 7 7 TAX LgT 1, /O/Oo OTINER:/rr ADDRESS: /Z aam wk Btz/PH0NE #:_19CITY: ADDRESS:- ,,*.n*f#fff;;wJ res you to STATE: PHONB 726-6 27 _zrp,ZZz 7 --ztPrZT? 2 ixPrRESrZg It: CITY:STATE: CONSTRUCAION CONTRACTORS REGISTRATION *:6 A7 /n /,/n BY SIGNING THIS PERHIT/APPLICATION' I AGREB TO CALL FOR AN IN: IECTIoN ONCI TrrEBACKFLOV PREVENTION DEVICE HES NUEN INSTALLED AIIO TS VISIBLE : IN INSPECTI()N(726-3769). r ALso srATE TIIAT ALL rNPoRMATroll tu rrrrs pERMrr ,\ppLrcATroN rsCORRECT. /-2/ FOR OFFTCE USE DT, DATE OF /,PPLICATI0N: tzlt lrr RECETPT {,: 0z2zc-to ISSUED BY: TOTAL AHOUNT COLLECTED:IZ. { o 18 lis / lo, L,^ h^4 il tl (trryeu 'h. a 46neE: {