HomeMy WebLinkAboutBuilding Plumbing 1996-10-03SPRTNGFIELD
BACKFLOW PREVENTION DBVICB PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFBTY DIVISION
%
225 FIFTH STREET
SPRINGFIELD OR 97477
OIIFICE:
INSPECTION LINE:
726-37s9
726-3769
JOB LOCATION:14
ASSESSoRSMAPitz l7 03 35 J.l
OllNER: t",)o 1/;'-, / l3u ,1, fi* . /*, Z /*-
OPP b
5
TAX LOT fi: /)fv
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ADDRESS: qqq S,-u, A,ni Q an1 2 PHONE *: Jqq-?oyC
STATE: OA ZTPz 97 c>/
$15.00 + $.75 (STATB SURCHARGE) + $.45 (ADMIN. FEE) = 516.20
5-6
BACKFLOIJ PERMIT IS
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CONTRACT0R: p / E Ola u. Tou )4^ k-
ADDRESS:./)6oo./n/c-<
PHONB *: 7/ l-/// t -7)f7c2 ')
CITY: Er.nn,STATE: OK ZTPz gTqol
CONSTRUCTION CONTRACTORS REGISTRATION *:70 EXPIREST o'Z-6^-72
BY SIGNING TIIIS PERMIT/APPLICATION, I AGREB T0 CALL roR AN INSPECTIoN oNCE TUE
BACKFLOV PREVBNTION DEVICE HAS BEBN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSo STATE TIIAT ALL TNFoRMATToN 0N Trrrs PERMTT/APPLrCATroN rS
CORRBCT.
D** /Z*-/o-3- 74sfcNrtwEDA_TE
FOR OFFICE USB
n
DATE OF APPLICATION:/o-a3-?a
REcErPr *, c).2357 ISSUED BYi n ln deA ctnl 1
JoB {r ,1Q I 3 Z1
TOTAL AMOUNT COLLECTED:g 3) 4r>
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CITY: Fu.u u-